Provider Demographics
NPI:1750719027
Name:CLEAVENGER, SANDI LYNN (BSN RN)
Entity type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:LYNN
Last Name:CLEAVENGER
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:MISS
Other - First Name:SANDI
Other - Middle Name:LYNN
Other - Last Name:NORIEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN RN
Mailing Address - Street 1:696 NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5726
Mailing Address - Country:US
Mailing Address - Phone:234-525-5887
Mailing Address - Fax:
Practice Address - Street 1:696 NEWCASTLE DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5726
Practice Address - Country:US
Practice Address - Phone:234-525-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.382698163W00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide