Provider Demographics
NPI:1033876750
Name:DOMINGO, JENNIFER TUMAMAO (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TUMAMAO
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13428 31ST DR SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5643
Mailing Address - Country:US
Mailing Address - Phone:206-779-0770
Mailing Address - Fax:
Practice Address - Street 1:13428 31ST DR SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5643
Practice Address - Country:US
Practice Address - Phone:206-779-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60276681163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty