Linda Dominguez, CNP
Individual provider Active NPI Obstetrics & Gynecology Nurse Practitioner · Alb, NM
NPI 1265491146 · NPPES record last updated Aug 13, 2008
Key facts
- NPI
- 1265491146
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Nurse Practitioner 363LX0001X
- License
- R20342 (NM)
- Practice address
- 883 Lead Avenue SE Suite a
Alb, NM 87102 - Phone
- (505) 843-7131
- Fax
- (505) 246-9421
- NPI assigned
- Mar 21, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R20342 | NM | MD | Obstetrics & Gynecology Nurse Practitioner |
Interoperability endpoints
- ldominguez170920@ahs.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | R20342 | NM | Yes |
Addresses
Primary practice location
883 Lead Avenue SE Suite a
Alb, NM 87102
Mailing address
883 Lead Ave SE
Ste a
Albuquerque, NM 87102-3644
Phone (505) 843-7131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91447 | Medicaid | NM |
Other providers in Alb, NM
- Gary Andrew Aisenbrey
- Larry Steve Archuleta Sr. Sr.
- Kent Frank Argubright
- Jennifer Judith Burns
- Valerie L Romero-Leggott
- Ashley Elizabeth Solomon Nelson
All providers in Alb, NM · Obstetrics & Gynecology Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.