Individual
BARBARA DOMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
22314 105TH AVE, QUEENS VILLAGE, NY 11429-2110
(718) 776-8722
Mailing address
22314 105TH AVE, QUEENS VILLAGE, NY 11429-2110
(718) 776-8722
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
304008
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
304008
LPN LICENSE
NY
Enumeration date
03/08/2011
Last updated
03/08/2011
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