Provider Demographics
NPI:1801492699
Name:BRINKLEY, DOMINIQUE (CNA)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:BRINKLEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 SYLVIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6124
Mailing Address - Country:US
Mailing Address - Phone:215-501-6317
Mailing Address - Fax:
Practice Address - Street 1:2005 SYLVIA ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6124
Practice Address - Country:US
Practice Address - Phone:215-501-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1678883747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant