Provider Demographics
NPI:1982484796
Name:FRANCIS, DOMINIQUE PATRICE (MTP, PSYD,CNA,)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:PATRICE
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:MTP, PSYD,CNA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SW 7TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4548
Mailing Address - Country:US
Mailing Address - Phone:515-329-6207
Mailing Address - Fax:
Practice Address - Street 1:500 SW 7TH ST STE 205
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4548
Practice Address - Country:US
Practice Address - Phone:515-329-6207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA242404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist