Healthcare Provider Details

I. General information

NPI: 1083296198
Provider Name (Legal Business Name): DAWN MARIE MATUSZ MS, NDTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 CLAYMONT ST APT 1
LAS VEGAS NV
89119-6810
US

IV. Provider business mailing address

4236 CLAYMONT ST APT 1
LAS VEGAS NV
89119-6810
US

V. Phone/Fax

Practice location:
  • Phone: 702-244-0078
  • Fax:
Mailing address:
  • Phone: 702-244-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: