Provider Demographics
NPI:1760991996
Name:DOMINICI, MARA E (CRNP)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:E
Last Name:DOMINICI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:E
Other - Last Name:FRANKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:1200 S CEDAR CREST BLVD FL 3
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-8355
Practice Address - Fax:610-402-2877
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN639232163W00000X
PASP018124363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily