Provider Demographics
NPI:1407839731
Name:CLEVELAND, JANE B (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:B
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:B
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:914 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01985-1307
Mailing Address - Country:US
Mailing Address - Phone:978-255-1086
Mailing Address - Fax:
Practice Address - Street 1:18 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3812
Practice Address - Country:US
Practice Address - Phone:978-462-9571
Practice Address - Fax:978-462-1459
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1691363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical