Individual
AMANDA MARIE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6128 E 38TH ST, TULSA, OK 74135-5832
(800) 722-3611
Mailing address
6128 E 38TH ST, TULSA, OK 74135-5832
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
148638
KS
Other
Enumeration date
04/21/2026
Last updated
04/21/2026
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