Provider Demographics
NPI:1619006657
Name:CLEAVENGER, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:CLEAVENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BLACK BROOK RD
Mailing Address - Street 2:
Mailing Address - City:AQUINNAH
Mailing Address - State:MA
Mailing Address - Zip Code:02535-1546
Mailing Address - Country:US
Mailing Address - Phone:508-645-9265
Mailing Address - Fax:508-645-2813
Practice Address - Street 1:1605 3RD AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2440
Practice Address - Country:US
Practice Address - Phone:980-565-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268990163WP2201X
CA22674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care