Provider Demographics
NPI:1194412692
Name:LOGO, DAWNESHIA
Entity type:Individual
Prefix:
First Name:DAWNESHIA
Middle Name:
Last Name:LOGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWNESHIA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3651 NORWOOD AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-4277
Mailing Address - Country:US
Mailing Address - Phone:916-579-2140
Mailing Address - Fax:
Practice Address - Street 1:3651 NORWOOD AVE APT 10
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-4277
Practice Address - Country:US
Practice Address - Phone:916-579-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula