Provider Demographics
NPI:1457383804
Name:DOMINICK, ANN GOWDY (FNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:GOWDY
Last Name:DOMINICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BOW ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5515
Mailing Address - Country:US
Mailing Address - Phone:410-996-5100
Mailing Address - Fax:
Practice Address - Street 1:401 BOW ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5515
Practice Address - Country:US
Practice Address - Phone:410-996-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172719363LF0000X
DELG-0000385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ63890Medicare UPIN