Provider Demographics
NPI:1144950478
Name:JACKSON-DAY, DASHIA MONQIUE
Entity type:Individual
Prefix:
First Name:DASHIA
Middle Name:MONQIUE
Last Name:JACKSON-DAY
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 1:10134 N PORT WASHINGTON RD
Mailing Address - Street 2:DASHIA DAY
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:141-459-9395
Mailing Address - Fax:
Practice Address - Street 1:10134 N PORT WASHINGTON RD
Practice Address - Street 2:DASHIA DAY
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:141-459-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIJ2531739268803172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver