Amanda Joy Dominik, CNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

7377 Issued in MN

Practice address

4411 Arden View CT
Arden Hills, MN 55112-1944

Phone

(651) 331-0827

NPI assigned

Apr 23, 2020

Last updated

Apr 23, 2020By the provider in NPPES

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 MN

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

Certified Nurse Practitioner

State licenses

Practice roles

Locations

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

• Gillette Children's Specialty Healthcare

  dba Gillette Children's Professional Services

  • Multi-Specialty Clinic/Center
  • Saint Paul, MN
  • NPI 1225119175
  Medicare reassignment NPD
• Gillette Children's Specialty Healthcare

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1982090528
  NPD

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

{
    "created_epoch": "1587600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1518587120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 ARDEN VIEW CT",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551121944",
            "telephone_number": "651-331-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 ARDEN VIEW CT",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551121944",
            "telephone_number": "651-331-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINIK",
        "first_name": "AMANDA",
        "middle_name": "JOY",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-23",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "7377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Jane Dixey
• Lwandile Dlamini
• Melissa Jacquella Dobbs
• Amelia Dodge
• Rose Marie Dominguez Sommerfeld, LPN
• Preston Drew Dorn
• Austyn Michael Dries
• Ellen Dorothy Dufresne
• Gordon Michael Dullin-Hess
• Sonya Eastham, LPCC

• Pediatric Nurse Practitioner in Arden Hills, MN
• Providers in Arden Hills, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.