Healthcare Provider Details

I. General information

NPI: 1790820843
Provider Name (Legal Business Name): DIANNE JEANETTE DOMBROWSKI RN FA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7548 N 7TH AVE
PHOENIX AZ
85021
US

IV. Provider business mailing address

7548 N 7TH AVE
PHOENIX AZ
85021
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-1259
  • Fax: 602-433-7798
Mailing address:
  • Phone: 602-870-1259
  • Fax: 602-433-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN032163
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: