Provider Demographics
NPI:1093171456
Name:DOMENECH, DAWN JANNICE (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:JANNICE
Last Name:DOMENECH
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:J
Other - Last Name:BYARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2851 S AVENUE B
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7726
Mailing Address - Country:US
Mailing Address - Phone:928-376-0026
Mailing Address - Fax:
Practice Address - Street 1:888 W 16TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4542
Practice Address - Country:US
Practice Address - Phone:928-550-7000
Practice Address - Fax:928-550-7006
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP8363363LA2200X, 363LG0600X
AZAP8363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology