Miranda Dominguez
Nurse Practitioner, Gerontology in Peoria, IL. Individual provider (NPI-1).
NPI number1528972775
StatusActive
Last updated in NPPESOct 14, 2026
Details
- NPI
- 1528972775
- Entity type
- Individual (NPI-1)
- Name
- Miranda Dominguez
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 2, 2026
- Certification date
- Oct 14, 2026
- Last updated
- Oct 14, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LG0600X | Nurse Practitioner, Gerontology | 209036661 | IL | Yes |
| 363LC0200X | Nurse Practitioner, Critical Care Medicine | 209.036661 | IL |
Practice location
530 Ne Glen Oak AvePeoria, IL 61637-0001
Phone 309-655-2000
Mailing address
1712 Flagstone DrNormal, IL 61761-9581
Phone 217-898-1367
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All 29 Gerontology Nurse Practitioner providers in Peoria · All 5,546 providers in Peoria
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