Provider Demographics
NPI:1972996841
Name:DOMINGO, COURTNEY R (WHNP-BC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:T
Other - Last Name:RUBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2545 W FRYE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-505-4258
Mailing Address - Fax:480-275-8346
Practice Address - Street 1:16611 S 40TH ST
Practice Address - Street 2:SUITE 180
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0562
Practice Address - Country:US
Practice Address - Phone:480-785-2100
Practice Address - Fax:480-785-2111
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7646363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health