Provider Demographics
NPI:1407665839
Name:DOMINGUEZ-WALTERS, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:DOMINGUEZ-WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6139
Mailing Address - Country:US
Mailing Address - Phone:402-462-5176
Mailing Address - Fax:402-462-5120
Practice Address - Street 1:602 W F ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6034
Practice Address - Country:US
Practice Address - Phone:402-834-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion