# MRS. JESSICA MARIE DOMIRE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1790293116
- **Gender:** F
- **Credential:** APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | NUR-APRN-LIC-146098 | MT | Yes |
| 363LF0000X | Family Nurse Practitioner | NUR-APRN-LIC-146098 | MT | — |

## Other

- **Enumeration date:** 01/19/2018
- **Last updated:** 03/17/2022