Healthcare Provider Details

I. General information

NPI: 1801941216
Provider Name (Legal Business Name): VICTORIA LEIGH DOMBROWSKI RN, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22509 AVON ST
SAINT CLAIR SHORES MI
48082-1481
US

IV. Provider business mailing address

22509 AVON ST
SAINT CLAIR SHORES MI
48082-1481
US

V. Phone/Fax

Practice location:
  • Phone: 586-285-9909
  • Fax: 586-723-9585
Mailing address:
  • Phone:
  • Fax: 586-723-9585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069498
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704286320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: