Provider Demographics
NPI:1700049152
Name:CLEVELAND, EILEEN MELODY (ARNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MELODY
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0059
Mailing Address - Country:US
Mailing Address - Phone:541-241-3071
Mailing Address - Fax:541-241-8031
Practice Address - Street 1:1813 W HARVARD AVE STE 233
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8704
Practice Address - Country:US
Practice Address - Phone:541-240-3071
Practice Address - Fax:541-241-8031
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201708443NP-PP363LF0000X, 363LF0000X
MSA810394363LF0000X
WAIP 60022566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID912107945Medicaid