Healthcare Provider Details

I. General information

NPI: 1336845890
Provider Name (Legal Business Name): CHERITA CRANON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W GRAND BLVD
DETROIT MI
48208-2336
US

IV. Provider business mailing address

1145 W GRAND BLVD
DETROIT MI
48208-2336
US

V. Phone/Fax

Practice location:
  • Phone: 313-324-8900
  • Fax:
Mailing address:
  • Phone: 248-818-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: