Provider Demographics
NPI:1093532160
Name:DOMINY, JUSTICE ELIZAH
Entity type:Individual
Prefix:
First Name:JUSTICE
Middle Name:ELIZAH
Last Name:DOMINY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZAH
Other - Middle Name:
Other - Last Name:DOMINY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25107 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-9702
Mailing Address - Country:US
Mailing Address - Phone:206-954-3069
Mailing Address - Fax:
Practice Address - Street 1:25107 34TH AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-9702
Practice Address - Country:US
Practice Address - Phone:206-954-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula