Provider Demographics
NPI:1447026877
Name:DOMINICCI, ANAHI (NP)
Entity type:Individual
Prefix:
First Name:ANAHI
Middle Name:
Last Name:DOMINICCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 HARKLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4784
Mailing Address - Country:US
Mailing Address - Phone:505-473-7546
Mailing Address - Fax:
Practice Address - Street 1:6729 4TH ST NW STE 3
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6114
Practice Address - Country:US
Practice Address - Phone:505-620-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner