Provider Demographics
NPI:1750898466
Name:CLEEK, MANDY (APRN, CRNA)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:CLEEK
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:MANCY
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CRNA
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:GRUETLI LAAGER
Mailing Address - State:TN
Mailing Address - Zip Code:37339-0100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2341 MCCALLIE AVE STE 402
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3231
Practice Address - Country:US
Practice Address - Phone:423-648-2720
Practice Address - Fax:423-624-6355
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23743367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered