Provider Demographics
NPI:1346481892
Name:CLIFF, CLEOPATRA J (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CLEOPATRA
Middle Name:J
Last Name:CLIFF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:CLEOPATRA
Other - Middle Name:J
Other - Last Name:DEVINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-1278
Mailing Address - Country:US
Mailing Address - Phone:217-337-2000
Mailing Address - Fax:
Practice Address - Street 1:2000 S MAYS ST STE 201
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7580
Practice Address - Country:US
Practice Address - Phone:512-244-4272
Practice Address - Fax:512-244-2895
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041321238163W00000X
TXAP140350367500000X
IL209007654041321238367500000X
IL209007654367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse