Provider Demographics
NPI:1164407656
Name:CLEVELAND, DEBBIE S (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:S
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 CANE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35151-5948
Mailing Address - Country:US
Mailing Address - Phone:256-267-3562
Mailing Address - Fax:256-827-0808
Practice Address - Street 1:301 MARIARDEN RD
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-6254
Practice Address - Country:US
Practice Address - Phone:256-825-7871
Practice Address - Fax:256-827-0808
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AL1-051971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL540003420Medicaid
ALS36563Medicare UPIN