Provider Demographics
NPI:1679612725
Name:KLEVE, CHERYL ANN (MPA, RD, LD)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:KLEVE
Suffix:
Gender:F
Credentials:MPA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 COLLINS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6847
Mailing Address - Country:US
Mailing Address - Phone:678-471-9658
Mailing Address - Fax:
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-674-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered