Provider Demographics
NPI:1548529100
Name:DOMINGO, EVELYN AGLIAM (RN)
Entity type:Individual
Prefix:MISS
First Name:EVELYN
Middle Name:AGLIAM
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PS 224@26-RM333-195-02-69TH AVE.
Mailing Address - Street 2:FRESH MEADOWS
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:718-464-4396
Mailing Address - Fax:718-264-1077
Practice Address - Street 1:PS 224@26-RM.333-195-02-69TH AVE.
Practice Address - Street 2:FRESH MEADOWS
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:718-464-4396
Practice Address - Fax:418-264-1077
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY285792-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse