Individual
BRIAN KEITH DOMINICCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
7320 SW HUNZIKER RD STE 300, TIGARD, OR 97223-2302
(503) 941-3077
Mailing address
7320 SW HUNZIKER RD STE 300, TIGARD, OR 97223-2302
(503) 941-3077
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201909621LPN
OR
Other
Enumeration date
07/01/2022
Last updated
07/01/2022
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