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General NPI Number Information
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NPI Number | 1255213492
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Entity Type | Individual
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Provider Name | LAURA ASHLEY DOMENIGO APRN
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 4002 24TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1894
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Country | US
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Telephone | 806-725-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 5905 GRINNELL ST
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City | LUBBOCK
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State | TX
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Zip | 79416-1590
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Country | US
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Telephone | 325-245-5095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1207199
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License Number State | TX
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