Provider Demographics
NPI:1659643963
Name:BROWN, DOMINIQUE NICOLE (LVN)
Entity type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-2017
Mailing Address - Country:US
Mailing Address - Phone:707-384-5650
Mailing Address - Fax:
Practice Address - Street 1:2243 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-2017
Practice Address - Country:US
Practice Address - Phone:707-384-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253087164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse