Provider Demographics
NPI:1639707037
Name:TENNEY-DOMANSKI, ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:TENNEY-DOMANSKI
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 1:281 RHINEBECK RD
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-6503
Mailing Address - Country:US
Mailing Address - Phone:518-530-7900
Mailing Address - Fax:
Practice Address - Street 1:281 RHINEBECK RD
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-6503
Practice Address - Country:US
Practice Address - Phone:518-530-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682523163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse