| NPI | 1013279025 |
|---|---|
| Former Name | TIFFANY JEANETTE DOMINGUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH PN.132935-M-IV) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2012-06-14 |