Basic Information
| Provider Information | |||||||||
| NPI: | 1245810290 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOMINGUEZ | ||||||||
| FirstName: | LOURDES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 WAKEFIELD DR | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030622109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034388115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 GRIFFIN BROOK DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018441865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786892400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2021 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LN97936 | MA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.