Doctor Name: | JOANNA BETH DOMINICK |
NPI Number: | 1174788145 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C, MSN, BSN |
License Number: | 5295 |
Business Practice Address: | 418 S Sligo St Cortez, CO - 813214718 |
Business Phone Number: | 9705644855 |
Business Fax Number: | 9705655455 |
Mailing Address: | 1311 N Mildred Rd, CORTEZ |
State: | CO |
Postal Code: | 813212231 |
Phone Number: | 9705642104 |
Fax Number: | 9705642134 |
NPI Enumeration Date: | 07/18/2008 |
NPI Last Update Date: | 11/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5295 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |