Individual
MR. RICHARD ANDREW DOMITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1804 FAIRVIEW ST, OSHKOSH, WI 54901-2404
(920) 235-6205
Mailing address
1804 FAIRVIEW ST, OSHKOSH, WI 54901-2404
(920) 235-6205
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
127665-30
WI
163WC0400X
Case Management Registered Nurse
127665-30
WI
163WH0200X
Home Health Registered Nurse
127665-30
WI
Other
Enumeration date
11/06/2013
Last updated
11/06/2013
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