Basic Information
| Provider Information | |||||||||
| NPI: | 1922587740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEVLEAND | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7610 ECHINACEA DR | ||||||||
| Address2: | |||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775218246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282167575 | ||||||||
| FaxNumber: | 7139793806 | ||||||||
| Practice Location | |||||||||
| Address1: | 4828 LOOP CENTRAL DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770812212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139793800 | ||||||||
| FaxNumber: | 7139793806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2018 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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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 | 163WG0000X | 891617 | MS | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.