Provider Demographics
NPI:1073377594
Name:CAMPOS, DOMINEK DANIELLE (RN)
Entity Type:Individual
Prefix:
First Name:DOMINEK
Middle Name:DANIELLE
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 REDWOOD ST APT 4103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0839
Mailing Address - Country:US
Mailing Address - Phone:702-753-3053
Mailing Address - Fax:
Practice Address - Street 1:2301 REDWOOD ST APT 4103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0839
Practice Address - Country:US
Practice Address - Phone:702-753-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV868033163WH1000X, 163WW0101X, 163WH0200X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Multi-Specialty
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WH0200XNursing Service ProvidersRegistered NurseHome Health