Provider Demographics
NPI:1245998251
Name:DOMINGUEZ, GABRIELA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-1505
Mailing Address - Country:US
Mailing Address - Phone:570-348-6100
Mailing Address - Fax:570-969-8955
Practice Address - Street 1:329 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1505
Practice Address - Country:US
Practice Address - Phone:570-348-6100
Practice Address - Fax:570-969-8955
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024825163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult