Provider Demographics
NPI:1508544057
Name:WASHINGTON-JEFFERSON, DIONKA LATEASE (BSN)
Entity Type:Individual
Prefix:
First Name:DIONKA
Middle Name:LATEASE
Last Name:WASHINGTON-JEFFERSON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:DIONKA
Other - Middle Name:LATEASE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:38442 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-5338
Mailing Address - Country:US
Mailing Address - Phone:734-637-7461
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse