Basic Information
| Provider Information | |||||||||
| NPI: | 1962040501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURDIN | ||||||||
| FirstName: | DOMINIQUE | ||||||||
| MiddleName: | ROCHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 835 SWEITZER ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375696931 | ||||||||
| FaxNumber: | 9372239811 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453901722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379687416 | ||||||||
| FaxNumber: | 9379683026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2019 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN.CNP.025226 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.