Provider Demographics
NPI:1093141731
Name:CORDERO, KELLY MARIE (NP, CNS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:CORDERO
Suffix:
Gender:F
Credentials:NP, CNS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:695 MONTEREY BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2363
Mailing Address - Country:US
Mailing Address - Phone:714-330-5612
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DRIVE, HC029
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5222
Practice Address - Country:US
Practice Address - Phone:650-701-5936
Practice Address - Fax:650-721-5079
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA22532363L00000X
CA3686364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist