Provider Demographics
NPI:1164088514
Name:DOMINGUEZ, CINDY PRISCILLA (ACNPC-AG)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:PRISCILLA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:PRISCILLA
Other - Last Name:VALDEZ SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:634 SW MULVANE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2224
Mailing Address - Country:US
Mailing Address - Phone:785-272-2240
Mailing Address - Fax:785-272-2250
Practice Address - Street 1:1700 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2489
Practice Address - Country:US
Practice Address - Phone:785-295-8155
Practice Address - Fax:785-295-5543
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78698363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner