Provider Demographics
NPI:1841432564
Name:CORDOVA, CECILIA LORRAINE (CFNP)
Entity Type:Individual
Prefix:PROF
First Name:CECILIA
Middle Name:LORRAINE
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MRS
Other - First Name:LORRAINE
Other - Middle Name:CECILIA
Other - Last Name:CORDOVA-CARRIAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFNP
Mailing Address - Street 1:4425 SAN ISIDRO ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2840
Mailing Address - Country:US
Mailing Address - Phone:505-345-5887
Mailing Address - Fax:866-265-6465
Practice Address - Street 1:1608 ISLETA BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4634
Practice Address - Country:US
Practice Address - Phone:505-907-8311
Practice Address - Fax:866-265-6465
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR17186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30254Medicaid
NM30254Medicaid