Provider Demographics
NPI:1861027781
Name:PRUITT, DAWNIESHA JENAY (LPN)
Entity Type:Individual
Prefix:
First Name:DAWNIESHA
Middle Name:JENAY
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 WINDMILL WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3340
Mailing Address - Country:US
Mailing Address - Phone:513-344-4247
Mailing Address - Fax:
Practice Address - Street 1:1854 WINDMILL WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3340
Practice Address - Country:US
Practice Address - Phone:513-344-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170610164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse