Healthcare Provider Details

I. General information

NPI: 1821695404
Provider Name (Legal Business Name): SIMONE NICOLE DOMME FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 04/24/2022
Certification Date: 04/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9362 TEDDY LN STE 204
LONE TREE CO
80124-2871
US

IV. Provider business mailing address

9362 TEDDY LN STE 204
LONE TREE CO
80124-2871
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-7278
  • Fax:
Mailing address:
  • Phone: 720-507-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: