Provider Demographics
NPI:1730222563
Name:DOMAINGUE, KARA BETH (RD)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:BETH
Last Name:DOMAINGUE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AZALEA LANE
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029
Mailing Address - Country:US
Mailing Address - Phone:860-454-7043
Mailing Address - Fax:
Practice Address - Street 1:200 PITKIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3220
Practice Address - Country:US
Practice Address - Phone:860-282-6266
Practice Address - Fax:860-282-6274
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000663133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal