DOMINIQUE ELY AGACNP-BC NPI 1629490081

NPI Information

  • NPI: 1629490081
  • Provider Name: DOMINIQUE ELY, AGACNP-BC
  • Classification: Nurse Practitioner - 363LA2100X
  • Specialization: Acute Care
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 302 W HAY ST STE 140
    DECATUR, IL
    ZIP 62526
  • Phone: (217) 872-2713

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NPI Details

Dominique Ely, AGACNP-BC is an acute care nurse practitioner in Decatur, IL with 12 years of experience. Dominique Ely, AGACNP-BC NPI is 1629490081. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduation Year:2013

The provider's business location address is:

302 W HAY ST STE 140
DECATUR, IL
ZIP 62526-168
Phone: (217) 872-2713
Fax: (217) 545-1958

The NPI 1629490081 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/20/2014 and was last updated on 9/24/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse Practitioner209011112ILLINOISNo
2363LA2200XNurse PractitionerAdult Health209011112ILLINOISNo
3363LG0600XNurse PractitionerGerontology209011112ILLINOISNo
4363LA2100XNurse PractitionerAcute Care209011112ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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