Provider Demographics
NPI:1366523276
Name:DOMANOWSKI, NANCY A (DPM)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:DOMANOWSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9823 LAKE AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1200
Mailing Address - Country:US
Mailing Address - Phone:216-281-5074
Mailing Address - Fax:
Practice Address - Street 1:14401 SNOW RD STE 102
Practice Address - Street 2:
Practice Address - City:BROOK PARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2583
Practice Address - Country:US
Practice Address - Phone:216-267-0304
Practice Address - Fax:216-267-1077
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003237213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist