MEDICARE: NANCY LEIGH DOMBROSKY PHRN

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	146L00000X	Paramedic	068868	PA

General Provider Information

NPI Number	:	1568453652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LEIGH DOMBROSKY PHRN

Provider Business Mailing Address
First Line	:	1491 CENTER AVE
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-1009
Country	:	US
Telephone Number	:	570-325-9972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1491 CENTER AVE
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-1009
Country	:	US
Telephone Number	:	570-325-9972
Fax Number	:

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

Provider Enumeration Date	:	10/29/2005
Last Update Date	:	07/08/2007

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