Individual
JENNA MAE DOMINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
2300 WESTERN AVE, MANITOWOC, WI 54220
(920) 320-3512
Mailing address
937 S 39TH ST, MANITOWOC, WI 54220-4707
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
218918-30
WI
363LF0000X
Family Nurse Practitioner
Primary
8540-33
WI
Other
Enumeration date
05/16/2018
Last updated
01/23/2019
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