Provider Demographics
NPI:1306002183
Name:MINER PREATOR, CORTNEY DAWN (RN)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:DAWN
Last Name:MINER PREATOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:DAWN
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:325 N BERGIN LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NM
Mailing Address - Zip Code:87413-6729
Mailing Address - Country:US
Mailing Address - Phone:505-634-2121
Mailing Address - Fax:505-634-3675
Practice Address - Street 1:325 N BERGIN LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-6729
Practice Address - Country:US
Practice Address - Phone:505-634-3673
Practice Address - Fax:505-634-3675
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY850163W00000X
NM74947163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse