Deadre L Domer, RN

Primary specialty

Maternal Newborn Registered NurseTaxonomy code 163WM0102X

License

041278524 Issued in IL

Practice address

31 W 155TH St
Harvey, IL 60426-3556

Phone

(708) 596-5177

NPI assigned

Apr 29, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1760065577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15620 Wood St",
            "address_purpose": "LOCATION",
            "city": "Harvey",
            "state": "IL",
            "postal_code": "604264171",
            "country_code": "US",
            "telephone_number": "708-596-5177",
            "fax_number": "708-596-5518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMER",
        "first_name": "DEADRE",
        "middle_name": "L",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-29",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "IL",
            "license": "041278524",
            "primary": false
        },
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "IL",
            "license": "041278524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS",
            "identifier": "041278524",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peggy P Demikis, PHYSICIAN ASSISTANT
• Jennifer A Deneen, P.A.
• Shamit Shailendra Desai, MD
• Shelly T Dixon, M.D.
• Sierra Dockery
• Ripple Rajesh Doshi, M.D.
• Leah Dright
• Nancy R. Dumont, OT
• Guadalupe Duran, APRN
• Joseph R Durham, M.D.

• Maternal Newborn Registered Nurse in Harvey, IL
• Providers in Harvey, IL by specialty
• Maternal Newborn Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; 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.