Provider Demographics
NPI:1104700095
Name:WALKER, DOMINIQUE (PHLEBOTOMIST)
Entity type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CHURCH ST N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4515
Mailing Address - Country:US
Mailing Address - Phone:980-271-9956
Mailing Address - Fax:
Practice Address - Street 1:308 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4515
Practice Address - Country:US
Practice Address - Phone:980-271-9956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy