Individual
JODY NEAL DOMINGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15790 PAUL VEGA MD DR, HAMMOND, LA 70403-1434
(985) 345-2700
Mailing address
15790 PAUL VEGA MD DRIVE, CREDENTIALING, HAMMOND, LA 70403-3087
(985) 345-2700
(985) 230-6652
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP02656
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1678741
—
LA
01
—
430035514
RR MEDICARE NUMBER
—
Enumeration date
07/01/2006
Last updated
01/06/2023
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