Provider Demographics
NPI:1376121491
Name:DOMINI, OLIVIA ANDREA (DNP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANDREA
Last Name:DOMINI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 24TH AVE E APT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3658
Mailing Address - Country:US
Mailing Address - Phone:425-463-5241
Mailing Address - Fax:
Practice Address - Street 1:26401 PACIFIC HWY S STE 101
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-9247
Practice Address - Country:US
Practice Address - Phone:206-870-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60865805163W00000X
WAAP61182754363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily