Individual provider · Type 1 NPI
Miranda Dominguez
Gerontology Nurse Practitioner · Peoria, IL
NPI number
1528972775
Active
Practice location
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Mailing address
1712 Flagstone Dr
Normal, IL 61761-9581
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Critical Care Medicine Nurse Practitioner | 363LC0200X | 209.036661 (IL) |
| Gerontology Nurse Practitioner Primary | 363LG0600X | 209036661 (IL) |
Gerontology Nurse Practitioner: Definition to come...
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About NPI 1528972775
Miranda Dominguez's National Provider Identifier is 1528972775, issued on Oct 2, 2026. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Peoria, IL. The record was last updated on Oct 14, 2026.