Provider Information for 1255709606
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URAINA DOMON MSW
Sex: Female
NPI: 1255709606
Last Updated: 2020-12-18
Certification Date: 2020-12-18
Certification Date: 2020-12-18
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1255709606 | ||||||||
| Enumeration Date | 2015-09-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 30 TRENTON, MO 64683-0030 United States Phone: 660-359-4487 | Fax:660-359-2958 | ||||||||
| Primary Practice Address | 1102 W HELM ST BROOKFIELD, MO 64628-7309 United States Phone: 660-359-4487 | Fax:660-359-2958 | ||||||||
| Secondary Practice Address(es) | 401 YOUSSEF DR 1601 E 28TH ST 220 E 3RD ST | ||||||||
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