Provider Demographics
NPI:1912358375
Name:POINDEXTER, DOMANICE (ACNPC-AG)
Entity Type:Individual
Prefix:MRS
First Name:DOMANICE
Middle Name:
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR
Mailing Address - Street 2:STE 150
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:203-325-5700
Mailing Address - Fax:
Practice Address - Street 1:CAREMORE HEALTH
Practice Address - Street 2:444 FOXON RD
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-533-5911
Practice Address - Fax:475-238-6372
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.006640363LA2100X
CT6640363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTMP3969752OtherDEA