Provider Demographics
NPI:1568011658
Name:DOMINGO, MYRA KRIZZHA MAE RIBAO (RN)
Entity Type:Individual
Prefix:MISS
First Name:MYRA KRIZZHA MAE
Middle Name:RIBAO
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-844 KEHUE ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2736
Mailing Address - Country:US
Mailing Address - Phone:808-381-3073
Mailing Address - Fax:
Practice Address - Street 1:91-844 KEHUE ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2736
Practice Address - Country:US
Practice Address - Phone:808-381-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-94487163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse