Provider Demographics
NPI:1821719527
Name:ECHOLS, JAQUADA JAN'EE
Entity Type:Individual
Prefix:
First Name:JAQUADA
Middle Name:JAN'EE
Last Name:ECHOLS
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 1:1236 BLAIRWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-6024
Mailing Address - Country:US
Mailing Address - Phone:937-825-4258
Mailing Address - Fax:
Practice Address - Street 1:1236 BLAIRWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-6024
Practice Address - Country:US
Practice Address - Phone:937-825-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)