Provider Demographics
NPI:1104373620
Name:DEAR, DOMINIQUE (CNA)
Entity Type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:
Last Name:DEAR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 N. HUDSON ST.
Mailing Address - Street 2:APT.594
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5828
Mailing Address - Country:US
Mailing Address - Phone:312-513-6525
Mailing Address - Fax:
Practice Address - Street 1:1365 N. HUDSON ST.
Practice Address - Street 2:APT.594
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5828
Practice Address - Country:US
Practice Address - Phone:312-513-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0564-1436163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation