Individual
DEADRE L DOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
Mailing address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
041278524
IL
163WM0102X
Maternal Newborn Registered Nurse
Primary
041278524
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041278524
STATE OF ILLINOIS
IL
Enumeration date
04/29/2021
Last updated
07/07/2021
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