MEDICARE: MRS. JENNIFER CLEVELAND RD, CDE

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	133V00000X	Registered Dietitian	803793	IN

General Provider Information

NPI Number	:	1679853766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER CLEVELAND RD, CDE

Provider Business Mailing Address
First Line	:	575 RILEY HOSPITAL DR RM XE086
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5272
Country	:	US
Telephone Number	:	317-944-3614
Fax Number	:	317-948-7095

Provider Business Practice Location Address
First Line	:	575 RILEY HOSPITAL DR RM XE086
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5272
Country	:	US
Telephone Number	:	317-944-3614
Fax Number	:	317-948-7095

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

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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