Healthcare Provider Details

I. General information

NPI: 1790166304
Provider Name (Legal Business Name): DEBORAH RHEA DOMINICI RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH RHEA REILLY RN, IBCLC

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4976 KELA PL APT D
EWA BEACH HI
96706-3121
US

IV. Provider business mailing address

4976 KELA PL APT D
EWA BEACH HI
96706-3121
US

V. Phone/Fax

Practice location:
  • Phone: 808-292-4232
  • Fax:
Mailing address:
  • Phone: 808-292-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN-42561
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: