Healthcare Provider Details

I. General information

NPI: 1215330436
Provider Name (Legal Business Name): HALINA DOMBKOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DALE RD STE 202
AVON CT
06001-3692
US

IV. Provider business mailing address

30 JORDAN LANE
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-644-1521
  • Fax: 860-644-3335
Mailing address:
  • Phone: 860-845-0905
  • Fax: 860-913-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005489
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: