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General NPI Number Information
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NPI Number | 1558283630
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Entity Type | Individual
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Provider Name | GRACIE DOMBROSKI
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 605 MAIN ST
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City | DURYEA
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State | PA
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Zip | 18642-1325
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Country | US
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Telephone | 570-457-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 212 BENNETT ST
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City | EXETER
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State | PA
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Zip | 18643-1209
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Country | US
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Telephone |
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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 | SP036647
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License Number State | PA
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