CLEVELAND VA CBOC NPI 1063439966

NPI Information

  • NPI: 1063439966
  • Provider Name: CLEVELAND VA CBOC
  • Classification: Licensed Practical Nurse - 164W00000X
  • Entity Type: Organization
  • CLIA Number: 52D1016783
  • Address: 1205 NORTH AVE
    CLEVELAND, WI
    ZIP 53015
  • Phone: (188) 846-9661

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NPI Details

CLEVELAND VA CBOC is a licensed practical nurse in Cleveland, WI. The provider is a licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. CLEVELAND VA CBOC NPI is 1063439966. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1205 NORTH AVE
CLEVELAND, WI
ZIP 53015-413
Phone: (188) 846-9661

The provider's authorized official is Stacey Jean Hibbard .
The authorized official title is Lpn and has the following contact phone number (920) 693-5600.

The CLIA number assigned to this NPI record is 52D1016783 - community clinic with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 7/16/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1164W00000XLicensed Practical Nurse18107-031WISCONSINYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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