| Doctor Name: | DOMINIQUE GUADALUPE |
| NPI Number: | 1316351133 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 338763 |
| Business Practice Address: | 100 John Roemmelt Dr Suite 202 Horseheads, NY - 148458301 |
| Business Phone Number: | 6077952820 |
| Business Fax Number: | 6077952821 |
| Mailing Address: | 722 W Water St, ELMIRA |
| State: | NY |
| Postal Code: | 149052435 |
| Phone Number: | 6072712050 |
| Fax Number: | |
| NPI Enumeration Date: | 06/19/2014 |
| NPI Last Update Date: | 04/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 338763 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |