Provider Demographics
NPI:1851916431
Name:DOMINACH, NICOLE ELISE (DNP, APRN, AGPCNP-BP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELISE
Last Name:DOMINACH
Suffix:
Gender:F
Credentials:DNP, APRN, AGPCNP-BP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 604
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1385
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-242-1300
Practice Address - Fax:585-473-5007
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY771327-01163W00000X
NYF309643-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse