MEDICARE: MISS BRITTANY ANN DOMINGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	5274	NC
2	367500000X	Certified Registered Nurse Anesthetist	218084	NC

General Provider Information

NPI Number	:	1669855813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRITTANY ANN DOMINGUEZ

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-3202

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-3202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	12/08/2025

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Directions to “ MISS BRITTANY ANN DOMINGUEZ ” Practice Location

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