Basic Information
| Provider Information | |||||||||
| NPI: | 1750898466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEEK | ||||||||
| FirstName: | MANDY | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN, CRNA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SANDERS | ||||||||
| OtherFirstName: | MANCY | ||||||||
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| OtherCredential: | APRN, CRNA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 100 | ||||||||
| Address2: | |||||||||
| City: | GRUETLI LAAGER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373390100 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2341 MCCALLIE AVE STE 402 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236482720 | ||||||||
| FaxNumber: | 4236246355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2018 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 23743 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.