MEDICARE: MRS. SHARON FREEMAN CLEVENGER MA, MSN, PMHCNS-BC

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
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	70000153A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1612	OTHER	IN	PHP

General Provider Information

NPI Number	:	1174527899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON FREEMAN CLEVENGER MA, MSN, PMHCNS-BC

Provider Business Mailing Address
First Line	:	423 AIRPORT NORTH OFFICE PARK
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6704
Country	:	US
Telephone Number	:	260-969-5583
Fax Number	:	260-969-5584

Provider Business Practice Location Address
First Line	:	423 AIRPORT NORTH OFFICE PARK
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6704
Country	:	US
Telephone Number	:	260-969-5583
Fax Number	:	260-969-5584

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	11/26/2014

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