Provider Demographics
NPI:1679853766
Name:CLEVELAND, JENNIFER (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 RILEY HOSPITAL DR RM XE086
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5272
Mailing Address - Country:US
Mailing Address - Phone:317-944-3614
Mailing Address - Fax:317-948-7095
Practice Address - Street 1:575 RILEY HOSPITAL DR RM XE086
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5272
Practice Address - Country:US
Practice Address - Phone:317-944-3614
Practice Address - Fax:317-948-7095
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN803793133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered