Active NPI
Denise Ann Cleveland, MA, RD, LD
- Registered Dietitian
- Brainerd, MN
National Provider Identifier
1801977053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1053
- Practice address
- 523 N 3Rd St
Brainerd, MN 56401-3054 - Phone
- (218) 828-7640
- NPI assigned
- Oct 17, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1053 | MN | Primary |
Addresses
Primary practice location
523 N 3Rd St
Brainerd, MN 56401-3054
Mailing address
19304 Woods Edge Trail
Brainerd, MN 56401
Phone (218) 825-0980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1053 | MN | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801977053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19304 WOODS EDGE TRAIL",
"city": "BRAINERD",
"state": "MN",
"postal_code": "56401",
"telephone_number": "218-825-0980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "523 N 3RD ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564013054",
"telephone_number": "218-828-7640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVELAND",
"first_name": "DENISE",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "MA, RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "1053",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brainerd, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.