Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APN2003 | SC |
NPI | 1033163670 |
---|---|
Provider Name | Mrs. Marcia L Cleveland |
First Address | Charlotte, NC 28275-1649 |
Second Address | Charleston, SC 29401-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 28/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G57197 | (02) | SC |