Provider Demographics
NPI:1376821686
Name:CROSS, TONESHA (CPM, LM)
Entity type:Individual
Prefix:
First Name:TONESHA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 BIGGER ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-1838
Mailing Address - Country:US
Mailing Address - Phone:219-741-3678
Mailing Address - Fax:
Practice Address - Street 1:1134 BIGGER ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1838
Practice Address - Country:US
Practice Address - Phone:219-741-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI95-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife