Healthcare Provider Details

I. General information

NPI: 1558622498
Provider Name (Legal Business Name): CHERELLE BARKSDALE B.S.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8660 AMARANTH LN
YPSILANTI MI
48197-1071
US

IV. Provider business mailing address

47 N HURON ST
YPSILANTI MI
48197-2607
US

V. Phone/Fax

Practice location:
  • Phone: 734-624-4102
  • Fax:
Mailing address:
  • Phone: 734-484-3600
  • Fax: 734-484-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704252761
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704252761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: