Provider Demographics
NPI:1154522134
Name:CLEVESY, MARCIA A (APN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:CLEVESY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:A
Other - Last Name:POULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5715981
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89157-1581
Mailing Address - Country:US
Mailing Address - Phone:702-439-4537
Mailing Address - Fax:
Practice Address - Street 1:1950 PINTO LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4017
Practice Address - Country:US
Practice Address - Phone:702-439-4537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN 000868363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACL NP3747Medicare ID - Type UnspecifiedMEDICARE B PROGRAM
MAP54858Medicare UPIN