Individual
NICHOLE CLEAVENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5300 ELLIOTT DR, YPSILANTI, MI 48197-8632
(734) 434-6262
Mailing address
1540 PENINSULA CT, CANTON, MI 48187-6623
(313) 347-3788
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.354451
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
4704259222
MI
367500000X
Certified Registered Nurse Anesthetist
COA.12963
OH
Other
Enumeration date
11/30/2011
Last updated
03/06/2023
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