Healthcare Provider Details

I. General information

NPI: 1891617379
Provider Name (Legal Business Name): DENISE DELILAH CROSS CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 E MICHIGAN AVE
JACKSON MI
49202-3518
US

IV. Provider business mailing address

1418 E MICHIGAN AVE
JACKSON MI
49202-3518
US

V. Phone/Fax

Practice location:
  • Phone: 517-416-8297
  • Fax: 517-783-1899
Mailing address:
  • Phone: 517-416-8297
  • Fax: 517-783-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: