Provider Demographics
NPI:1518338466
Name:CALDWELL, TONYA
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:
Last Name:CALDWELL
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 1:1982 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2519
Mailing Address - Country:US
Mailing Address - Phone:313-208-1791
Mailing Address - Fax:
Practice Address - Street 1:16589 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3707
Practice Address - Country:US
Practice Address - Phone:313-427-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7338018OtherPROVIDER IDENTIFICATION