Healthcare Provider Details

I. General information

NPI: 1609978584
Provider Name (Legal Business Name): CLAIRE J DOMBROCK GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 WESTGATE DR STE 100
SAINT PAUL MN
55114-1451
US

IV. Provider business mailing address

7601 FRANCE AVE S SUITE 270
EDINA MN
55435-5968
US

V. Phone/Fax

Practice location:
  • Phone: 612-262-7800
  • Fax:
Mailing address:
  • Phone: 952-841-2345
  • Fax: 952-841-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number878
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: