NPI 1013626597

Mary Domine

Practitioner Specialist Waite Park, MN

Practice location

Address: 423 Great Oak Dr, Waite Park, MN 56387-2507
Phone: (218) 287-4338
Mailing address: 1547 30th Ave S, Moorhead, MN 56560-5149

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X

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Registry record

NPI: 1013626597
Entity type: Individual
Sex (as registered): Female
NPI issued: 23 Nov 2022
Record last updated: 23 Nov 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.