Provider Demographics
NPI:1972603363
Name:CLEVELAND, NANCY M (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:7601 FRANCE AVE S
Mailing Address - Street 2:SUITE 270
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5968
Mailing Address - Country:US
Mailing Address - Phone:952-841-2345
Mailing Address - Fax:952-841-2346
Practice Address - Street 1:7601 FRANCE AVE S
Practice Address - Street 2:SUITE 270
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5968
Practice Address - Country:US
Practice Address - Phone:952-841-2345
Practice Address - Fax:952-841-2346
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX612679363LF0000X
MNR 187403-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183446701Medicaid
TX183446701Medicaid
TX8J0664Medicare ID - Type Unspecified