Provider Demographics
NPI:1114537677
Name:DOMINGUEZ, LORI ELIZABETH (RN)
Entity Type:Individual
Prefix:MISS
First Name:LORI
Middle Name:ELIZABETH
Last Name:DOMINGUEZ
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:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-0295
Mailing Address - Country:US
Mailing Address - Phone:718-514-3672
Mailing Address - Fax:
Practice Address - Street 1:2 W 32ND ST STE 502
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-0595
Practice Address - Country:US
Practice Address - Phone:646-678-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY79600601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse