Doctor Name: | MRS. D J DOMSTEAD |
NPI Number: | 1063673077 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 223021 |
Business Practice Address: | 601 University Dr San Marcos, TX - 786664685 |
Business Phone Number: | 5122450335 |
Business Fax Number: | |
Mailing Address: | 601 University Dr, SAN MARCOS |
State: | TX |
Postal Code: | 786664685 |
Phone Number: | 5122450335 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2008 |
NPI Last Update Date: | 06/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WC1400X |
License Number: | 223021 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | College Health |
Taxonomy Definition: |