Provider Demographics
NPI:1083896872
Name:CLEVELAND, ANNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18902 ODELL RD
Mailing Address - Street 2:
Mailing Address - City:FRAZEYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43822
Mailing Address - Country:US
Mailing Address - Phone:740-828-2437
Mailing Address - Fax:
Practice Address - Street 1:18902 ODELL RD
Practice Address - Street 2:
Practice Address - City:FRAZEYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43822-9429
Practice Address - Country:US
Practice Address - Phone:740-828-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN312495163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse