Individual provider · Type 1 NPI
Carlo Domingo, AGNP-C
Gerontology Nurse Practitioner · Hainesville, IL
NPI number
1194251272
Active
Practice location
4 N Deer Point Dr, Ste 1002
Hainesville, IL 60030-3814
Mailing address
4 N Deer Point Dr., Ste 1002
Hainesville, IL 60030-3814
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 209.019378 (IL) |
| Gerontology Nurse Practitioner Primary | 363LG0600X | 209.019378 (IL) |
Gerontology Nurse Practitioner: Definition to come...
Another provider at this address
About NPI 1194251272
Carlo Domingo, AGNP-C's National Provider Identifier is 1194251272, issued on May 10, 2017. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Hainesville, IL. The record was last updated on Oct 11, 2021.