Provider Demographics
NPI:1558764233
Name:DIDOMENICO, GINETTE MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:GINETTE
Middle Name:MARIE
Last Name:DIDOMENICO
Suffix:
Gender:F
Credentials:ARNP
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 1162
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-1162
Mailing Address - Country:US
Mailing Address - Phone:425-221-4657
Mailing Address - Fax:
Practice Address - Street 1:27715 NE 20TH PL
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-8211
Practice Address - Country:US
Practice Address - Phone:425-221-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60508368363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health