MEDICARE: DAWN MARIE MATUSZ MS, NDTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	136A00000X	Registered Dietetic Technician

General Provider Information

NPI Number	:	1083296198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN MARIE MATUSZ MS, NDTR

Provider Business Mailing Address
First Line	:	4236 CLAYMONT ST APT 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6810
Country	:	US
Telephone Number	:	702-244-0078
Fax Number	:

Provider Business Practice Location Address
First Line	:	4236 CLAYMONT ST APT 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6810
Country	:	US
Telephone Number	:	702-244-0078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	04/27/2021

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