Healthcare Provider Details

I. General information

NPI: 1386934057
Provider Name (Legal Business Name): SUSAN M DOMBROWSKI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 N CHURCH DR
PARMA HEIGHTS OH
44130-4701
US

IV. Provider business mailing address

9050 N CHURCH DR
PARMA HEIGHTS OH
44130-4701
US

V. Phone/Fax

Practice location:
  • Phone: 440-292-0226
  • Fax:
Mailing address:
  • Phone: 440-292-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD3356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: