Provider Demographics
NPI:1821725888
Name:BLAGOJEVIC, DOMINIQUE NICOLE (CNP)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:NICOLE
Last Name:BLAGOJEVIC
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932909
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0026
Mailing Address - Country:US
Mailing Address - Phone:330-854-4281
Mailing Address - Fax:330-854-0032
Practice Address - Street 1:5147 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:NEW FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:44319-3911
Practice Address - Country:US
Practice Address - Phone:330-644-3747
Practice Address - Fax:330-644-9815
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031786363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care