Individual
MRS. JESSICA MARIE DOMIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
140 S CENTRAL AVE, MALTA, MT 59538
(406) 654-1953
Mailing address
PO BOX 581, MALTA, MT 59538-0581
(406) 301-2357
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NUR-APRN-LIC-146098
MT
363LF0000X
Family Nurse Practitioner
NUR-APRN-LIC-146098
MT
Other
Enumeration date
01/19/2018
Last updated
03/17/2022
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