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Individual

CARLO DOMINGO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
AGNP-C

Contact information

Practice address
4 N DEER POINT DR, STE 1002, HAINESVILLE, IL 60030-3814
(847) 946-0198
Mailing address
4 N DEER POINT DR., STE 1002, HAINESVILLE, IL 60030-3814
(847) 946-0198

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209.019378
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209.019378
IL

Other

Enumeration date
05/10/2017
Last updated
10/11/2021
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