Provider Demographics
NPI:1962106336
Name:VANCLEAVE, DESIREE MONET
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:MONET
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 12TH ST NW APT 3
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-3356
Mailing Address - Country:US
Mailing Address - Phone:330-412-5986
Mailing Address - Fax:
Practice Address - Street 1:1325 12TH ST NW APT 3
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-3356
Practice Address - Country:US
Practice Address - Phone:330-412-5986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide