Healthcare Provider Details

I. General information

NPI: 1154522134
Provider Name (Legal Business Name): MARCIA A CLEVESY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA A POULIN

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 PINTO LN
LAS VEGAS NV
89106-4017
US

IV. Provider business mailing address

PO BOX 5715981
LAS VEGAS NV
89157-1581
US

V. Phone/Fax

Practice location:
  • Phone: 702-439-4537
  • Fax:
Mailing address:
  • Phone: 702-439-4537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN 000868
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: