Provider Demographics
NPI:1295030641
Name:RAMOS, DOMINIQUE M (NP)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:M
Last Name:RAMOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E MARSHALL STREET
Mailing Address - Street 2:NRW 141
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4412
Mailing Address - Country:US
Mailing Address - Phone:610-431-5472
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL STREET
Practice Address - Street 2:NRW 141
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4412
Practice Address - Country:US
Practice Address - Phone:610-431-5472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN647153367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281955901Medicaid
TX1295030641OtherBLUE CROSS BLUE SHIELD
TXTXB126411Medicare PIN
TX1295030641OtherBLUE CROSS BLUE SHIELD