Provider Demographics
NPI:1689017188
Name:CORDOVEZ, ELLA DONALDO (NP)
Entity Type:Individual
Prefix:MS
First Name:ELLA
Middle Name:DONALDO
Last Name:CORDOVEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 SABA LN
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5419
Mailing Address - Country:US
Mailing Address - Phone:409-540-5928
Mailing Address - Fax:
Practice Address - Street 1:3061 SABA LN
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5419
Practice Address - Country:US
Practice Address - Phone:409-540-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX750859363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX750859OtherAPRN LICENSE NO