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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

MIRANDA DOMINGUEZ
NPI 1528972775
Nurse Practitioner - Gerontology in Peoria, IL

Active since October 02, 2026
530 NE GLEN OAK AVE, PEORIA, IL 61637(309) 655-2000 Get Directions Write a Review

NPPES record added: October 14, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 14, 2026, Oct 2, 2026 (2 updates tracked since 2026).

About Miranda Dominguez NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIRANDA DOMINGUEZ (NPI 1528972775) is an individual gerontology provider in Peoria, Illinois, licensed in Illinois (209036661) and active in the NPI registry since October 2026.

NPPES Registry Identity

NPI1528972775
Entity TypeIndividualFemale
Primary Taxonomy363LG0600X
Provider Legal NameMIRANDA DOMINGUEZ
Location Address530 NE GLEN OAK AVEPeoria, IL 61637-0001
Mailing Address1712 Flagstone DrNormal, IL 61761-9581 · (217) 898-1367
Phone(309) 655-2000
Sole ProprietorNo
Enumeration DateOctober 2, 2026
Last NPPES UpdateOctober 14, 20262 updates tracked since enumeration
NPPES CertifiedOctober 14, 2026
✔ NPI 1528972775 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LG0600X
License✔ Licensed in IL · 209036661
Also ListedNurse Practitioner · Critical Care MedicineTaxonomy 363LC0200X · License 209.036661 (IL)
530 NE GLEN OAK AVE, Peoria, IL 61637
Open in Google Maps ↗

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. HAMID MAHMOOD ZIA M.D
Pathology (Anatomic Pathology & Clinical Pathology)
530 NE GLEN OAK AVE, CENTRAL ILLINOIS PATHOLOGY SC
PEORIA, IL 61637
Peoria County (309) 624-9011
THOMAS JAMES MCMORROW MD
Pediatrics
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2553
ALEXANDRA ROPER MD
Surgery
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
JAPMEHR KAUR SANDHU M.B.B.S.
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 624-9351
THOMAS BLACKWELL JR. MD
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2000
LUKE KLOFT
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-2109
ABIGAIL V. WELU DO
Student in an Organized Health Care Education/Training Program
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-6710
DR. JAMES DANIEL DEWAR D.O.
Internal Medicine (Interventional Cardiology)
530 NE GLEN OAK AVE
PEORIA, IL 61637
Peoria County (309) 655-7257

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Miranda Dominguez's NPI number?

The NPI number for Miranda Dominguez is 1528972775. It was assigned to this individual provider in the NPPES registry on October 2, 2026.

Where is Miranda Dominguez located?

Miranda Dominguez practices at 530 NE Glen Oak Ave, Peoria, IL 61637. The listed phone number is (309) 655-2000.

What is Miranda Dominguez's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

When was this NPI record last updated?

The NPPES record for Miranda Dominguez was last updated on October 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.