Provider Demographics
NPI:1609158575
Name:HUGHES, DOMINIQUE LYNAE
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:LYNAE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 WILLIAMSBURG RD N
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-5137
Mailing Address - Country:US
Mailing Address - Phone:513-226-1942
Mailing Address - Fax:
Practice Address - Street 1:4112 WILLIAMSBURG RD N
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-5137
Practice Address - Country:US
Practice Address - Phone:513-226-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTH429922376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker