Provider Demographics
NPI:1164766689
Name:STAFFNEY, CLEVETA M
Entity Type:Individual
Prefix:
First Name:CLEVETA
Middle Name:M
Last Name:STAFFNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 S RAINBOW BLVD
Mailing Address - Street 2:#1117
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5481
Mailing Address - Country:US
Mailing Address - Phone:702-349-3523
Mailing Address - Fax:
Practice Address - Street 1:7600 S RAINBOW BLVD
Practice Address - Street 2:#1117
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-5481
Practice Address - Country:US
Practice Address - Phone:702-349-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner