Provider Demographics
NPI:1790820843
Name:DOMBROWSKI, DIANNE JEANETTE (RN FA)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:JEANETTE
Last Name:DOMBROWSKI
Suffix:
Gender:F
Credentials:RN FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7548 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-870-1259
Mailing Address - Fax:602-433-7798
Practice Address - Street 1:7548 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:602-870-1259
Practice Address - Fax:602-433-7798
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN032163163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0149230OtherBLUE CROSS BLUE SHIELD