Provider Demographics
NPI:1871236349
Name:DORNBUSCH, NAKIAH
Entity Type:Individual
Prefix:
First Name:NAKIAH
Middle Name:
Last Name:DORNBUSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 MOUNTAIN HERITAGE ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WV
Mailing Address - Zip Code:26704-7316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:369 MOUNTAIN HERITAGE ESTATES RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WV
Practice Address - Zip Code:26704-7316
Practice Address - Country:US
Practice Address - Phone:304-813-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer