Individual provider · Type 1 NPI

Jenna Mae Domino, APNP

Family Nurse Practitioner · Manitowoc, WI

NPI number 1780174664 Active

Practice location

2300 Western Ave
Manitowoc, WI 54220

Mailing address

937 S 39th St
Manitowoc, WI 54220-4707

Specialties and licenses

TaxonomyCodeLicense
Registered Nurse 163W00000X218918-30 (WI)
Family Nurse Practitioner Primary 363LF0000X8540-33 (WI)

Family Nurse Practitioner: Definition to come...

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About NPI 1780174664

Jenna Mae Domino, APNP's National Provider Identifier is 1780174664, issued on May 16, 2018. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Manitowoc, WI. The record was last updated on Jan 23, 2019.