Nicole Lyn Dominick, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

SP018244 Issued in PA

Practice address

1130 Highway 315 Blvd Ste 4
Wilkes Barre, PA 18702-6952

Phone

(570) 823-8896

Fax

(570) 270-2692

NPI assigned

Dec 4, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ndominick@renal.medentdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renal Consultants of Wyoming Valley PC

  • Nephrology Physician
  • Wilkes Barre, PA
  • NPI 1659399111
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513728000000",
    "number": "1306351028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 HIGHWAY 315 BLVD STE 4",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026952",
            "telephone_number": "570-823-8896",
            "fax_number": "570-270-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 HIGHWAY 315 BLVD STE 4",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026952",
            "telephone_number": "570-823-8896",
            "fax_number": "570-270-2692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINICK",
        "first_name": "NICOLE",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-04",
        "last_updated": "2017-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP018244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karim Djekidel, M.D.
• Doctor Butler Eyecare, LLC
• Laurel Foxworth Dodgson, MS, RPA-C
• Rachel Marie Dolk, LPC
• Passang Dolma, M.D.
• Jennifer Ann Dompkosky, CRNA
• Sean D Domzalski, PA-C
• Jennielu Donlin, RN
• Donna B. McLaughlin OD
• Matthew Dooley, PSY.D.

• Nurse Practitioner in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.