Provider Demographics
NPI:1487407300
Name:CLEVELAND, JODY (RN)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 25TH ST NW
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-3825
Mailing Address - Country:US
Mailing Address - Phone:360-460-1300
Mailing Address - Fax:
Practice Address - Street 1:1600 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3802
Practice Address - Country:US
Practice Address - Phone:360-589-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61490842163WH0200X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WH0200XNursing Service ProvidersRegistered NurseHome Health