Dewanda Crochrell

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

2116 Edison Ave
Granite City, IL 62040-4717

Phone

(618) 334-1181

NPI assigned

Nov 11, 2018

Last updated

Nov 11, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541894400000",
    "number": "1790253466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 KENNEDY DR",
            "city": "MADISON",
            "state": "IL",
            "postal_code": "620601236",
            "telephone_number": "618-334-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 EDISON AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404717",
            "telephone_number": "618-334-1181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCHRELL",
        "first_name": "DEWANDA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-11",
        "last_updated": "2018-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Health Worker in Granite City, IL
• Providers in Granite City, IL by specialty
• Community Health Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.