MEDICARE: LISA MARIE CLEVELAND NP

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	363LF0000X	Family Nurse Practitioner	AP109719	TX
2	363LP0200X	Pediatric Nurse Practitioner	AP109719	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	376046402	OTHER	TX	CSHCN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457675068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE CLEVELAND NP

Provider Business Mailing Address
First Line	:	7703 FLOYD CURL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3901
Country	:	US
Telephone Number	:	210-450-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 LIVE OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78202-1932
Country	:	US
Telephone Number	:	210-223-2944
Fax Number	:

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

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	03/17/2018

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