Provider Demographics
NPI:1710326442
Name:DOMANSKI, AMY MARIE (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:DOMANSKI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-3204
Mailing Address - Country:US
Mailing Address - Phone:908-208-2168
Mailing Address - Fax:
Practice Address - Street 1:755 MEMORIAL PKWY STE 302
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2771
Practice Address - Country:US
Practice Address - Phone:908-847-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027591363LF0000X
NJ26NJ00444600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily