Healthcare Provider Details

I. General information

NPI: 1497352025
Provider Name (Legal Business Name): MICHALEA EVETTE CRANSHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

20600 TRACY AVE
EUCLID OH
44123-3047
US

IV. Provider business mailing address

20600 TRACY AVE
EUCLID OH
44123-3047
US

V. Phone/Fax

Practice location:
  • Phone: 216-798-7024
  • Fax:
Mailing address:
  • Phone: 216-971-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.153013.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: