Provider Demographics
NPI:1609327857
Name:DAWSON, DOINITA
Entity Type:Individual
Prefix:
First Name:DOINITA
Middle Name:
Last Name:DAWSON
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 1:22284 N 102ND LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2657
Mailing Address - Country:US
Mailing Address - Phone:623-266-4934
Mailing Address - Fax:623-271-8325
Practice Address - Street 1:22284 N 102ND LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2657
Practice Address - Country:US
Practice Address - Phone:623-266-4934
Practice Address - Fax:623-271-8325
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9130H172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ843964Medicaid