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General NPI Number Information
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NPI Number | 1437855699
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Entity Type | Individual
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Provider Name | MICHELE LEE DOMINICK LPN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | MEDMARK TREATMENT CENTER 1037 COMPASS CIRCLE
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City | GREENSBURG
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State | PA
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Zip | 15601
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Country | US
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Telephone | 724-834-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 745 SHAWNEE LN
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City | LIGONIER
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State | PA
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Zip | 15658-3635
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Country | US
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Telephone | 724-963-2858
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN290055
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License Number State | PA
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