Provider Demographics
NPI:1962040501
Name:STEWART, DOMINIQUE ROCHELLE (CNP)
Entity Type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:ROCHELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:ROCHELLE
Other - Last Name:PURDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 SWEITZER ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331
Mailing Address - Country:US
Mailing Address - Phone:937-569-6931
Mailing Address - Fax:937-968-3026
Practice Address - Street 1:622 E ELM ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:OH
Practice Address - Zip Code:45390-1722
Practice Address - Country:US
Practice Address - Phone:937-968-7416
Practice Address - Fax:937-968-3026
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025226363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily