=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386934057
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN M DOMBROWSKI RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2011
-----------------------------------------------------
Last Update Date | 04/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9050 N CHURCH DR
-----------------------------------------------------
City | PARMA HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-292-0226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9050 N CHURCH DR
-----------------------------------------------------
City | PARMA HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-292-0226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133VN1005X
-----------------------------------------------------
Taxonomy Name | Renal Nutrition Registered Dietitian
-----------------------------------------------------
License Number | LD3356
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------