Doctor Name: | PATRICIA J. DOMYAN |
NPI Number: | 1053357111 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | C.R.N.P. |
License Number: | SP008796 |
Business Practice Address: | 522 Delaware Ave Fountain Hill, PA - 180151180 |
Business Phone Number: | 6108618977 |
Business Fax Number: | 6108619339 |
Mailing Address: | 522 Delaware Ave, FOUNTAIN HILL |
State: | PA |
Postal Code: | 180151180 |
Phone Number: | 6108618977 |
Fax Number: | 6108619339 |
NPI Enumeration Date: | 06/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP008796 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |