Provider Demographics
NPI:1942891734
Name:WYSE, DOMINIQUE ALECIA (CERTIFIED DOULA)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ALECIA
Last Name:WYSE
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 SAN FELIPE BLVD APT 708
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7656
Mailing Address - Country:US
Mailing Address - Phone:512-825-3219
Mailing Address - Fax:
Practice Address - Street 1:7800 SAN FELIPE BLVD APT 708
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7656
Practice Address - Country:US
Practice Address - Phone:512-825-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula