Provider Demographics
NPI:1134287865
Name:CLEVELAND, KAREN M (RD, CD)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4776
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46634-4667
Mailing Address - Country:US
Mailing Address - Phone:574-523-3148
Mailing Address - Fax:574-523-3492
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:NUTRITION SERVICES DEPARTMENT
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-3236
Practice Address - Fax:574-296-6504
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN720478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37000844AOtherCERTIFICATION NUMBER
IN720478OtherLICENSE
IN720478OtherLICENSE