DOMINIQUE ELY

DECATUR, IL
NPI1629490081
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LA2100X Nurse Practitioner, Acute Care
(Licence: IL  209011112)
Additional Taxonomies363L00000X Nurse Practitioner
(Licence: IL  209011112)
363LA2200X Nurse Practitioner, Adult Health
(Licence: IL  209011112)
363LG0600X Nurse Practitioner, Gerontology
(Licence: IL  209011112)
Enumeration Date2014-01-20
Last Update Date2024-09-24
Business Address
DOMINIQUE ELY AGACNP-BC
302 W HAY ST STE 140
DECATUR, IL 62526-4168
Phone number: 217-872-2713
Mailing Address
DOMINIQUE ELY AGACNP-BC
PO BOX 19639
SPRINGFIELD, IL 62794-9639
Phone number: 217-545-8000