Healthcare Provider Details

I. General information

NPI: 1558283630
Provider Name (Legal Business Name): GRACIE DOMBROSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAIN ST
DURYEA PA
18642-1325
US

IV. Provider business mailing address

212 BENNETT ST
EXETER PA
18643-1209
US

V. Phone/Fax

Practice location:
  • Phone: 570-457-1110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP036647
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: