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NPI Code Detail

MEDICARE: DORIS CLEVELAND RN

MEDICARE: DORIS CLEVELAND RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WX0002XHigh-Risk Obstetric Registered NurseRN076336AZ

General Provider Information

NPI Number : 1619172525
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORIS CLEVELAND RN
Provider Business Mailing Address
First Line : PO BOX 31001-0698
Second Line :
City : PASADENA
State : CA
Zip : 91110-0698
Country : US
Telephone Number : 602-263-1511
Fax Number : 602-263-1619
Provider Business Practice Location Address
First Line : 4212 N 16TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-5319
Country : US
Telephone Number : 602-263-1511
Fax Number : 602-263-1619
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2007
Last Update Date : 07/08/2007

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