Provider Demographics
NPI:1285447920
Name:VAN CLEVE, KAYLA CHARLENE (RN)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:CHARLENE
Last Name:VAN CLEVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-1673
Mailing Address - Country:US
Mailing Address - Phone:715-902-0848
Mailing Address - Fax:262-661-2206
Practice Address - Street 1:605 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1703
Practice Address - Country:US
Practice Address - Phone:715-902-0848
Practice Address - Fax:262-221-2206
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI221168163W00000X
WI0020610261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No163W00000XNursing Service ProvidersRegistered Nurse