Provider Demographics
NPI:1922004449
Name:CORDOVA, POLLY BENNETT (CNM)
Entity Type:Individual
Prefix:MRS
First Name:POLLY
Middle Name:BENNETT
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:POLLY
Other - Middle Name:A
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:5201 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7708
Mailing Address - Country:US
Mailing Address - Phone:214-590-1396
Mailing Address - Fax:214-590-1401
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-1396
Practice Address - Fax:214-590-1401
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616284367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037046202Medicaid
TX037046202Medicaid
TXP08698Medicare UPIN