Individual
MS. SHAUNA MARIE CLEVELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
209 N HURON CT, FAIRBORN, OH 45324-2775
(937) 430-6900
Mailing address
209 N HURON CT, FAIRBORN, OH 45324-2775
(937) 430-6900
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN 382765
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0073636
ODJFS MEDICAID PROVIDER NUMBER
OH
01
—
2903415
OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES CONTRACT NUMBER
OH
Enumeration date
08/28/2012
Last updated
11/21/2012
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