Provider Demographics
NPI:1720501117
Name:JONES, DOMINIQUE LACHA (DNP, CNM)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:LACHA
Last Name:JONES
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 26TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1244
Mailing Address - Country:US
Mailing Address - Phone:763-232-2336
Mailing Address - Fax:
Practice Address - Street 1:716 SOUTH 7TH STREET
Practice Address - Street 2:PURPLE BUILDING LEVEL 5
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:763-232-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNM04376367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife