Provider Demographics
NPI:1174032858
Name:CLEVELAND, CHRISTINE MARY (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARY
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 1:1047 E GENEVA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3804
Mailing Address - Country:US
Mailing Address - Phone:602-819-7490
Mailing Address - Fax:
Practice Address - Street 1:3501 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5767
Practice Address - Country:US
Practice Address - Phone:602-381-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN158350163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool