Dominick, Jacqueline D
Dominick, Jacqueline D is an individual health care provider with primary practice located at 301 Hospital Dr , Glen Burnie MD 21061-5803. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Dominick, Jacqueline D can be contacted via phone (410) 787-4000.Contact Information
Primary practice address
301 Hospital Dr
Glen Burnie MD 21061-5803
Phone: (410) 787-4000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | R097460 | Maryland |
Profile Details
| NPI number | 1366424921 |
|---|---|
| LBN Legal business name | Dominick, Jacqueline D |
| Credentials | CRNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 18th, 2005 |
| Last updated | Dec 3rd, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366424921 | NPPES |
| Maryland | Other | 4457 | BRAVO/ELDER HEALTH |
| Maryland | Other | 127573 | BRAVO/ELDER HEALTH |
| Maryland | MEDICAID | 408588400 | BRAVO/ELDER HEALTH |
| Maryland | Other | F591-0020 | BRAVO/ELDER HEALTH |
| Maryland | Other | 64696401 | BRAVO/ELDER HEALTH |
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