Provider Demographics
NPI:1205261724
Name:CLEVELAND, MICHELLE LEE (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6317 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2778
Mailing Address - Country:US
Mailing Address - Phone:262-812-7819
Mailing Address - Fax:
Practice Address - Street 1:3401 N PERRYVILLE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8011
Practice Address - Country:US
Practice Address - Phone:815-971-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010685041.383842363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health