Provider Demographics
NPI:1497071591
Name:ROBERTS, CHERYL R
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:R
Last Name:ROBERTS
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 1:8510 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1121
Mailing Address - Country:US
Mailing Address - Phone:313-468-9875
Mailing Address - Fax:313-468-9875
Practice Address - Street 1:8510 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1121
Practice Address - Country:US
Practice Address - Phone:313-468-9875
Practice Address - Fax:313-468-9875
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374700000XNursing Service Related ProvidersTechnician