MR. WALLACE D CLEVELAND JR. (NPI# 1821510033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821510033 |
| Entity Type | Individual |
| Full Name | MR. WALLACE D CLEVELAND JR. |
| Credential | PA-C |
| Practice Address |
27th Special Operations Medical Group 224 W D.l. Ingram Ave Cannon Afb NM 88103-5103 |
| Practice Telephone | 5759043917 |
| Practice Fax Number | 5757845028 |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2019-11-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W D.L. INGRAM AVE |
| City | CANNON AFB |
| State | NM |
| Zip Code | 88103-5103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972833523 | Deborah J Angeles | Nurse Practitioner | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2010-01-04 |
| 1649814120 | Chase Chesterman | Dietitian, Registered | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2019-10-29 |
| 1134613342 | Nicholas F Polk | Social Worker | 27th Special Operations Medical Group, 224 W D.l. Ingram Ave, Cannon Afb, NM 88103-5103 | 2018-06-20 |
| 1144725755 | Kent Andrew Boucher | General Practice | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2018-03-26 |
| 1184137218 | Racheal L Rivera | Nurse Practitioner | 27th Special Operations Medical Group, 27 Somdg/sghc, Cannon Afb, NM 88103-5103 | 2017-11-11 |
| 1497104194 | Anne M Murphy | Pediatrics | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2016-06-03 |
| 1265848576 | John M Richardson | Family Medicine | 27th Special Operations Medical Group, 244 W D.l. Ingram Ave, Cannon Afb, NM 88101-5103 | 2014-07-08 |
| 1710287362 | Julie A Thomas | Nurse Practitioner | 27th Special Operations Medical Group, 224 W Dl Ingram Ave, Cannon Afb, NM 88103-5103 | 2010-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346747151 | Isabella Wolak | Pharmacist | 224 D L Ingram Blvd, Cannon Afb, NM 88103 | 2018-04-09 |
| 1225480544 | Stacey Tatro | Dentist | 224 West D.l. Ingram Ave., Bldg 1408, Cannon Afb, NM 88103 | 2016-07-11 |
| 1871965673 | Chad Bryan Carter | Dentist | 224 W Dl Ingram Ave, Sgpd/dental Clinic, Cannon Air Force Base, NM 88103 | 2015-10-20 |
| 1740660836 | Terah Clifford | Dental Hygienist | 224 W Dl Ingram Blvd, Bldg 1408 Dental Clinic, Cannon Afb, NM 88103 | 2015-06-03 |
| 1528452208 | Taylor Bottari | Physician Assistant | 208 W Dl Ingram, Cannon Afb, NM 88103 | 2015-03-20 |
| 1588071328 | Gretchen Evelynn Szymanski | Nurse Practitioner | Cannon Afb, 224 W D.l. Ingram Blvd, Cannon Afb, NM 88103 | 2014-07-14 |
| 1396155206 | Jennifer Brynn Bendokas | Physician Assistant | 224 West Dl Ingram Avenue, Cannon Afb, NM 88103 | 2014-04-30 |
| 1366889487 | Jeremy Michael Strohmayer | General Practice | 511 Chindt Blvd Building 300, 27soss/osm, Cannon Afb, NM 88103 | 2013-05-30 |
| 1356622401 | Matthew John Nielsen | Dentist | 224 W D.l. Ingram, Bld. 1408, Cannon Afb, NM 88103 | 2011-09-02 |
| 1689965485 | Bryan Wade Sixkiller | Optometrist | 27th Somdg, 208 W. Casa Blanca Ave., Apo, AA 88103 | 2011-04-27 |
| Find all providers in zip 88103 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407300767 | Keith Powell | Physician Assistant | 224 W D.l. Ingram Ave, Bdg 1408, Cannon Afb, NM 88103-5103 | 2016-08-04 |
| 1588111090 | Shannon Freshwater Long | Physician Assistant | 208 W Dl Ingram, Cannon Afb, NM 88103 | 2016-09-01 |
| 1740426923 | Justin David Wright | Physician Assistant | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2008-12-18 |
| 1104071729 | Donald Joseph Trigg | Physician Assistant | 208 W Casablanca Ave, 100, Cannon Afb, NM 88103-5009 | 2008-11-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902405442 | Lauren Elise Pincomb Apodaca | Physician Assistant | 2415 Janet Ann Ln, Las Cruces, NM 88007-5119 | 2020-10-24 |
| 1609474550 | Mara Swartzentruber | Physician Assistant | 3310 Linda Vista Ave Se, Albuquerque, NM 87106-1514 | 2020-10-13 |
| 1336757301 | Dailey Doss | Physician Assistant | Raymond G. Murphy Va Medical Center, 1501 San Pedro Se, Albuquerque, NM 87108 | 2020-07-16 |
| 1487287413 | Thomas Clise | Physician Assistant | 629 San Pablo St Ne, Albuquerque, NM 87108-2137 | 2020-02-18 |
| 1306478870 | Holly Howe | Physician Assistant | 2300 Grande Blvd Se # 4045, Rio Rancho, NM 87124-1755 | 2020-02-12 |
| 1427680750 | Mckenzi Hoffman | Physician Assistant | 465 Saint Michaels Dr Bldg Suite107, Santa Fe, NM 87505-7670 | 2020-02-05 |
| 1225678543 | Charla Marie Dunn | Physician Assistant | 701 Arizona St Ste A, Clovis, NM 88101-2110 | 2020-01-14 |
| 1912547324 | Kathleen Joyce L'heureux | Physician Assistant | 8124 Ventana Cielo Ave Nw, Albuquerque, NM 87114-5988 | 2020-01-14 |
| 1033752357 | Daniel Ray Spohn | Physician Assistant | 1630 Rio Rancho Dr Se, Rio Rancho, NM 87124-1587 | 2019-10-18 |
| 1528615101 | Michael La | Physician Assistant | 1202 Main St Ne Ste A, Los Lunas, NM 87031-7421 | 2019-08-20 |
| Find all providers with the same taxonomy | ||||
| City | CANNON AFB |
| Zip Code | 88103 |
Please comment or provide details below to improve the information on MR. WALLACE D CLEVELAND JR..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.