Provider Demographics
NPI:1073383279
Name:WALDRON, CINDY K (RN)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:K
Last Name:WALDRON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:QUEMADO
Mailing Address - State:NM
Mailing Address - Zip Code:87829-0430
Mailing Address - Country:US
Mailing Address - Phone:575-517-0760
Mailing Address - Fax:
Practice Address - Street 1:3484 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:QUEMADO
Practice Address - State:NM
Practice Address - Zip Code:87829-9600
Practice Address - Country:US
Practice Address - Phone:575-773-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61212172A00000X
NM401672163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No172A00000XOther Service ProvidersDriver