Provider Demographics
NPI:1396511085
Name:MARKS, DOMINIQUE M
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:M
Last Name:MARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26392 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3169
Mailing Address - Country:US
Mailing Address - Phone:216-858-9986
Mailing Address - Fax:
Practice Address - Street 1:26392 MORNING GLORY LN
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-3169
Practice Address - Country:US
Practice Address - Phone:216-858-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN470150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse