Provider Demographics
NPI:1871267609
Name:WAFER, KEONA LASHAWN
Entity Type:Individual
Prefix:
First Name:KEONA
Middle Name:LASHAWN
Last Name:WAFER
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 1:140 B ST # 6-142
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4653
Mailing Address - Country:US
Mailing Address - Phone:530-204-8918
Mailing Address - Fax:
Practice Address - Street 1:140 B ST # 5-142
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4653
Practice Address - Country:US
Practice Address - Phone:530-204-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)