JENNA MAE DOMINO (NPI# 1780174664) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780174664 |
| Entity Type | Individual |
| Full Name | JENNA MAE DOMINO |
| Credential | APNP |
| Practice Address |
2300 Western Ave Manitowoc WI 54220 |
| Mailing Address |
937 S 39th St Manitowoc WI 54220-4707 |
| Practice Telephone | 9203203512 |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2019-01-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 218918-30 | WI | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
8540-33 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2300 WESTERN AVE |
| City | MANITOWOC |
| State | WI |
| Zip Code | 54220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649264441 | Milan Jordan | Surgery | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2005-09-07 |
| 1114534823 | Hailey Elizabeth Boyer | Speech-Language Pathologist | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2020-09-26 |
| 1255971313 | Sara Lubner | Physical Therapy Assistant | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2020-01-07 |
| 1245889054 | Jeanne Edwards | Dietitian, Registered | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2019-09-05 |
| 1427610989 | Brianna Groelle | Physical Therapy Assistant | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2019-07-05 |
| 1659848505 | Holy Family Memorial Inc | Family Medicine | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2018-10-30 |
| 1811405467 | Holy Family Memorial Inc | Registered Nurse | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2018-01-17 |
| 1386160935 | Patricia Josephine Lohr | Occupational Therapy Assistant | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2017-08-16 |
| 1134668221 | Amanda Kay Werner | Physician Assistant | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2017-02-22 |
| 1558811489 | Jamie Christine Moline | Pharmacist | 2300 Western Ave, Manitowoc, WI 54220-3712 | 2016-10-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235614843 | Katherine Borchardt | Registered Nurse | 3520 Foxfire Ct, Manitowoc, WI 54220 | 2018-09-28 |
| 1285128215 | Aurora Pharmacy Inc | Pharmacy | 3509 Dewey Street, Suite 100, Manitowoc, WI 54220 | 2018-06-22 |
| 1477937274 | Baycare Clinic LLP | Psychiatry & Neurology | 4801 Expo Drive, Manitowoc, WI 54220 | 2015-07-13 |
| 1831593821 | Brittany Camille Schultz | Acupuncturist | 2510 Washington Street, Manitowoc, WI 54220 | 2014-10-20 |
| 1710311261 | Brian E Weitz | Physical Therapy Assistant | 960 S. Rapids Rd., Manitowoc, WI 54220 | 2013-09-01 |
| 1134499080 | Total Renal Care Inc | Clinic/Center | 3303 Dewey St, Manitowoc, WI 54220 | 2012-01-10 |
| 1679858534 | Lisa M Noworatzky | Marriage & Family Therapist | 926 S. 8th St., Manitowoc, WI 54220 | 2011-10-11 |
| 1306177225 | Cynthia Fay Wenzel | Licensed Practical Nurse | 915 East Linden Avenue, Manitowoc, WI 54220 | 2010-01-15 |
| 1851550628 | Roundys Supermarkets Inc | Pharmacy | 3300 Calumet Ave, Manitowoc, WI 54220 | 2008-06-05 |
| 1851566079 | Jennifer C Mcwilliams | Registered Nurse | 1004 Nth 8th St., Manitowoc, WI 54220 | 2008-04-29 |
| Find all providers in zip 54220 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750866646 | Ann Rojaz | Nurse Practitioner | 4810 Expo Dr, Manitowoc, WI 54220-9341 | 2018-09-26 |
| 1891320735 | June C Magnussen | Nurse Practitioner | 1650 S 41st St, Manitowoc, WI 54220-7316 | 2020-03-11 |
| 1891198735 | Jennifer L. Weier | Nurse Practitioner | 1900 Woodland Dr, Manitowoc, WI 54220-9662 | 2014-10-07 |
| 1821300443 | Cheryl L. Lustig | Nurse Practitioner | 1650 S 41st St, Manitowoc, WI 54220-7316 | 2010-07-12 |
| 1467552414 | Thomas E Brooks | Nurse Practitioner | 601 Reed Ave, Manitowoc, WI 54220-2026 | 2006-09-22 |
| 1013023597 | Barbara J Backus | Nurse Practitioner | 1650 S 41st St, Manitowoc, WI 54220-7316 | 2006-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982203857 | Tiera Manuel | Nurse Practitioner | 3956 N 28th St, Milwaukee, WI 53216-2637 | 2020-10-22 |
| 1801494778 | Tajana Jovicic | Nurse Practitioner | 3157 S 66th St, Milwaukee, WI 53219-4105 | 2020-10-13 |
| 1497352090 | Carlotta Williams | Nurse Practitioner | 1205 Juniper Ln, Oconomowoc, WI 53066-3100 | 2020-10-06 |
| 1932706611 | Rachel Sullivan | Nurse Practitioner | 304 E Northlawn Dr, Cottage Grove, WI 53527-8917 | 2020-10-05 |
| 1649877663 | Kirk O'hanison | Nurse Practitioner | 1020 Oconomowoc Pkwy Unit B, Oconomowoc, WI 53066-4616 | 2020-10-02 |
| 1780291401 | Carlie Dell | Nurse Practitioner | 1636 Industrial Pkwy N, Marinette, WI 54143-3703 | 2020-09-27 |
| 1093320459 | Tyronda T Gray | Nurse Practitioner | 5833 N 117th St, Milwaukee, WI 53225-2207 | 2020-09-12 |
| 1629683065 | Yia Lor | Nurse Practitioner | 3750 Summerset Way Apt 1, Oshkosh, WI 54901-0501 | 2020-09-11 |
| 1245844364 | Asia Ann Gomez | Nurse Practitioner | 2816 E Allison Ave, Cudahy, WI 53110-2541 | 2020-09-04 |
| 1861005837 | Clair Roser Rivera | Nurse Practitioner | 3734 W Ohio Ave, Milwaukee, WI 53215-4047 | 2020-08-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.