MEDICARE: DEBORAH CLEVELAND FNP,PMHNP

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	363L00000X	Nurse Practitioner	3987	MN
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	3987	MN
3	364SF0001X	Family Health Clinical Nurse Specialist	CNP 3987	MN

General Provider Information

NPI Number	:	1760833198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH CLEVELAND FNP,PMHNP

Provider Business Mailing Address
First Line	:	1900 SILVER LAKE RD NW STE 110
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-1789
Country	:	US
Telephone Number	:	651-628-9566
Fax Number	:	651-628-0411

Provider Business Practice Location Address
First Line	:	305 30TH AVE W
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-3429
Country	:	US
Telephone Number	:	320-460-8028
Fax Number	:

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

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	05/20/2026

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