Individual
MS. DEWANDA CROCHRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2116 EDISON AVE, GRANITE CITY, IL 62040-4717
(618) 334-1181
Mailing address
1605 KENNEDY DR, MADISON, IL 62060-1236
(618) 334-1181
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
11/11/2018
Last updated
11/11/2018
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