Provider Demographics
NPI:1174868244
Name:DOMINGUEZ, KAREN JOANNE (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JOANNE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JOANNE
Other - Last Name:SHELLITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5575 VAL VERDE RD
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-9442
Mailing Address - Country:US
Mailing Address - Phone:916-316-6174
Mailing Address - Fax:
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:SUITE 1400
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3444
Practice Address - Country:US
Practice Address - Phone:916-984-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily