Healthcare Provider Details

I. General information

NPI: 1669097127
Provider Name (Legal Business Name): DAWNMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E MAIN ST STE A
PULLMAN WA
99163-2660
US

IV. Provider business mailing address

540 E MAIN ST STE A
PULLMAN WA
99163-2660
US

V. Phone/Fax

Practice location:
  • Phone: 509-566-9779
  • Fax:
Mailing address:
  • Phone: 509-566-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHALEAH D JONES
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 509-566-9779