Healthcare Provider Details

I. General information

NPI: 1942918982
Provider Name (Legal Business Name): ALEXIS N DOMINIECKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 7TH AVE STE 3170
WEST READING PA
19611-1494
US

IV. Provider business mailing address

301 S 7TH AVE STE 3170
WEST READING PA
19611-1494
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-9386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064016
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA006312
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: