Provider Demographics
NPI:1659319374
Name:CLEVELAND, MARY BENTLEY (MSN RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BENTLEY
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18045 FAIRFIELD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2742
Mailing Address - Country:US
Mailing Address - Phone:313-407-1319
Mailing Address - Fax:
Practice Address - Street 1:18045 FAIRFIELD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2742
Practice Address - Country:US
Practice Address - Phone:313-407-1319
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse