Provider Demographics
NPI:1972111318
Name:CORDOVA, CASANDRA LEE (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:CASANDRA
Middle Name:LEE
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 VISTA COURT DR APT 5208
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8374
Mailing Address - Country:US
Mailing Address - Phone:956-739-2682
Mailing Address - Fax:
Practice Address - Street 1:350 VISTA COURT DR APT 5208
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8374
Practice Address - Country:US
Practice Address - Phone:956-739-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGPRN248542163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse