Provider Demographics
NPI:1245945831
Name:EDWARDS, DOMINIQUE C (DOULA)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:C
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 PENNINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-3126
Mailing Address - Country:US
Mailing Address - Phone:862-596-1554
Mailing Address - Fax:
Practice Address - Street 1:98 PENNINGTON ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-3126
Practice Address - Country:US
Practice Address - Phone:862-596-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula