Provider Demographics
NPI:1346651981
Name:MBACHIE, DOMINIQUE (RN)
Entity Type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:
Last Name:MBACHIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DOMINICA
Other - Middle Name:
Other - Last Name:MBACHIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7619 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 6000
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2625
Mailing Address - Country:US
Mailing Address - Phone:703-752-8700
Mailing Address - Fax:
Practice Address - Street 1:7619 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 6000
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2625
Practice Address - Country:US
Practice Address - Phone:703-752-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1016983163W00000X
MDR188756163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse