Provider Demographics
NPI:1740793652
Name:CLEVELAND, KWAJALEIN RONTOYA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KWAJALEIN
Middle Name:RONTOYA
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KWAJALEIN
Other - Middle Name:RONTOYA
Other - Last Name:FOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2952 NANTUCKETT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-8901
Mailing Address - Country:US
Mailing Address - Phone:843-729-5482
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE STE 1165
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2235
Practice Address - Country:US
Practice Address - Phone:404-223-9306
Practice Address - Fax:404-223-9307
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNM04165367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife