Healthcare Provider Details

I. General information

NPI: 1144154154
Provider Name (Legal Business Name): DASHONDA FULLER-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 N 14TH ST
MILWAUKEE WI
53206-2768
US

IV. Provider business mailing address

3167 N 14TH ST
MILWAUKEE WI
53206-2768
US

V. Phone/Fax

Practice location:
  • Phone: 414-628-2802
  • Fax:
Mailing address:
  • Phone: 414-628-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: