Provider Demographics
NPI:1629851423
Name:MCCRIGHT-GILBERT, TAJUANNA (MI000057505)
Entity Type:Individual
Prefix:
First Name:TAJUANNA
Middle Name:
Last Name:MCCRIGHT-GILBERT
Suffix:
Gender:F
Credentials:MI000057505
Other - Prefix:
Other - First Name:TAJUANNA
Other - Middle Name:
Other - Last Name:MCCRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20300 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1569
Mailing Address - Country:US
Mailing Address - Phone:313-401-6454
Mailing Address - Fax:
Practice Address - Street 1:20300 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1569
Practice Address - Country:US
Practice Address - Phone:313-401-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000057505374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide