Provider Demographics
NPI:1265656656
Name:CORDAHI-CRUZ, MARGUERITE LYNN (CFNP)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:LYNN
Last Name:CORDAHI-CRUZ
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:CORDAHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFNP
Mailing Address - Street 1:1808 OTOWI RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3301
Mailing Address - Country:US
Mailing Address - Phone:505-984-8772
Mailing Address - Fax:
Practice Address - Street 1:2801 RODEO RD
Practice Address - Street 2:SUITE B13
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-6503
Practice Address - Country:US
Practice Address - Phone:505-474-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR21861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR21861OtherLISCENCE