Healthcare Provider Details

I. General information

NPI: 1922483858
Provider Name (Legal Business Name): MICHAEL GEORGE CLEVELEY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 S UNIVERSITY BLVD
HIGHLANDS RANCH CO
80126-7802
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-470-4061
  • Fax: 303-470-4062
Mailing address:
  • Phone: 970-624-4123
  • Fax: 970-624-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0993263-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992363-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9310885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: