Provider Demographics
NPI:1679317135
Name:HENSON, DOMINIQUE LA'SHAWN (DOULA)
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:LA'SHAWN
Last Name:HENSON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13732 CAMBRIDGE ST
Mailing Address - Street 2:APT. 303
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1677
Mailing Address - Country:US
Mailing Address - Phone:313-801-7131
Mailing Address - Fax:
Practice Address - Street 1:13732 CAMBRIDGE ST
Practice Address - Street 2:APT. 303
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1677
Practice Address - Country:US
Practice Address - Phone:313-801-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula