Provider Demographics
NPI:1528774908
Name:DOMIER, SARAH KRISITNE (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISITNE
Last Name:DOMIER
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 1:2642 5TH CT W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8539
Mailing Address - Country:US
Mailing Address - Phone:218-820-5092
Mailing Address - Fax:
Practice Address - Street 1:3425 S WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7101
Practice Address - Country:US
Practice Address - Phone:218-820-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2494013163W00000X
NDR41981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse