Provider Demographics
NPI:1083296198
Name:MATUSZ, DAWN MARIE (MS, NDTR)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:MATUSZ
Suffix:
Gender:F
Credentials:MS, NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 CLAYMONT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6810
Mailing Address - Country:US
Mailing Address - Phone:702-244-0078
Mailing Address - Fax:
Practice Address - Street 1:4236 CLAYMONT ST APT 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6810
Practice Address - Country:US
Practice Address - Phone:702-244-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered