| NPI | 1679246441 |
|---|---|
| Former Name | DOMINIQUE MATTOCKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5016537) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024182605) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2023-02-28 |