MEDICARE: MS. JUANNA CHERISE HARDAWAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	6803085951	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144773722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUANNA CHERISE HARDAWAY

Provider Business Mailing Address
First Line	:	1935 PASADENA ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-2922
Country	:	US
Telephone Number	:	313-456-5513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 PASADENA
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238
Country	:	US
Telephone Number	:	313-456-5513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	07/29/2016

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