Provider Demographics
NPI:1932741022
Name:CLEAVER, DEIDRE FAWN
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:FAWN
Last Name:CLEAVER
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 1:2893 KLINGER CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1023
Mailing Address - Country:US
Mailing Address - Phone:661-448-5496
Mailing Address - Fax:
Practice Address - Street 1:2893 KLINGER CIR APT 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-1023
Practice Address - Country:US
Practice Address - Phone:661-448-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator