Individual provider Active NPI

Allison Sue Domer, RN

  • Registered Nurse
  • Hagerstown, MD
National Provider Identifier
1710168927
Registry record updated Nov 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R100629 Issued in MD
Practice address
13218 Brooklane Dr
Hagerstown, MD 21742-1435
Phone
(301) 733-0331
Fax
(301) 733-4038
NPI assigned
Nov 15, 2007
Last updated
Nov 15, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R100629 MD Primary

Addresses

Primary practice location

13218 Brooklane Dr
Hagerstown, MD 21742-1435

Mailing address

13218 Brooklane Dr
Hagerstown, MD 21742-1435
Phone (301) 733-0331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R100629MDMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195084800000",
    "number": "1710168927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13218 BROOKLANE DR",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217421435",
            "telephone_number": "301-733-0331",
            "fax_number": "301-733-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13218 BROOKLANE DR",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217421435",
            "telephone_number": "301-733-0331",
            "fax_number": "301-733-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMER",
        "first_name": "ALLISON",
        "middle_name": "SUE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-15",
        "last_updated": "2007-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MD",
            "license": "R100629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.