Provider Demographics
NPI:1235455155
Name:DOMIZIO, FILOMENA ANGELA
Entity Type:Individual
Prefix:MRS
First Name:FILOMENA
Middle Name:ANGELA
Last Name:DOMIZIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1914
Mailing Address - Country:US
Mailing Address - Phone:845-454-6513
Mailing Address - Fax:
Practice Address - Street 1:4 POPLAR ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1914
Practice Address - Country:US
Practice Address - Phone:845-454-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10148093164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10148093OtherLPN LICENSE