Provider Demographics
NPI:1396313169
Name:EDWARDS, CHERYL-ANN D
Entity type:Individual
Prefix:MISS
First Name:CHERYL-ANN
Middle Name:D
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4009
Mailing Address - Country:US
Mailing Address - Phone:248-996-5369
Mailing Address - Fax:248-281-4904
Practice Address - Street 1:18000 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4009
Practice Address - Country:US
Practice Address - Phone:248-996-5369
Practice Address - Fax:248-281-4904
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherHOME CARE