Provider Demographics
NPI:1518849298
Name:DORNBUSCH, CHARLI S
Entity type:Individual
Prefix:
First Name:CHARLI
Middle Name:S
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 1:6110 ROUNDHEAD RD
Mailing Address - Street 2:
Mailing Address - City:NEW VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45159-9398
Mailing Address - Country:US
Mailing Address - Phone:937-509-9472
Mailing Address - Fax:
Practice Address - Street 1:6110 ROUNDHEAD RD
Practice Address - Street 2:
Practice Address - City:NEW VIENNA
Practice Address - State:OH
Practice Address - Zip Code:45159-9398
Practice Address - Country:US
Practice Address - Phone:937-509-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion