Provider Demographics
NPI:1588653695
Name:CLEVELAND, VICKI A (APRN BC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:A
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:A
Other - Last Name:LEFEVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN BC
Mailing Address - Street 1:5150 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2601
Mailing Address - Country:US
Mailing Address - Phone:317-782-1577
Mailing Address - Fax:888-392-3210
Practice Address - Street 1:5150 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2601
Practice Address - Country:US
Practice Address - Phone:317-782-1577
Practice Address - Fax:888-392-3210
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28129743A163W00000X
IN71001372A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000351107OtherANTHEM
IN200382080AMedicaid
IN500027595OtherRR MEDICARE
IN500027595OtherRR MEDICARE
IN200382080AMedicaid