Individual
MRS. ASHLEY DOMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3584 FAIRLANES AVE SW, GRANDVILLE, MI 49418-1583
(616) 222-5494
Mailing address
44 KATHERINE DR NE, GRAND RAPIDS, MI 49505-4012
(231) 652-0106
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703124447
MI
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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