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Individual

MRS. MICHELLE ANN DOMANCHUK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APN

Contact information

Practice address
110 E SCHILLER ST, SUITE 318, ELMHURST, IL 60126-2858
(630) 832-1775
Mailing address
1107 ARLINGTON AVE, LA GRANGE, IL 60525-5811
(708) 354-0332
(708) 763-2162

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-001363
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
800012875
RAILROAD MEDICARE
IL
Enumeration date
06/10/2006
Last updated
08/22/2008
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