Basic Information
| Provider Information | |||||||||
| NPI: | 1821641994 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN CLEAVE | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP-C, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9895 W REMINGTON PL | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801286734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039482676 | ||||||||
| FaxNumber: | 3039049151 | ||||||||
| Practice Location | |||||||||
| Address1: | 9895 W REMINGTON PL | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801286734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039482676 | ||||||||
| FaxNumber: | 3039049151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2019 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.1617161 | CO | N | Nursing Service Providers | Registered Nurse | 363LF0000X | APN.0994981-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.