Provider Demographics
NPI:1689398505
Name:CLEVELAND, STACIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2971
Mailing Address - Country:US
Mailing Address - Phone:701-845-6550
Mailing Address - Fax:
Practice Address - Street 1:367 2ND ST NW
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-2971
Practice Address - Country:US
Practice Address - Phone:701-845-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily