Provider Demographics
NPI:1073498218
Name:BRYANT, DOMINIQUE GABRIELLE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:GABRIELLE
Last Name:BRYANT
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 1:380 BUCKEYE CIR
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-4376
Mailing Address - Country:US
Mailing Address - Phone:301-318-3843
Mailing Address - Fax:
Practice Address - Street 1:215 BROADUS ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1384
Practice Address - Country:US
Practice Address - Phone:888-659-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide