Provider Demographics
NPI:1851059307
Name:CLEAVELAND, MELISSA NICOLE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:CLEAVELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 RIDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-1394
Mailing Address - Country:US
Mailing Address - Phone:417-434-5898
Mailing Address - Fax:
Practice Address - Street 1:6035 W TRANSIT ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5097
Practice Address - Country:US
Practice Address - Phone:417-434-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005022626163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant