Provider Demographics
NPI:1972979060
Name:CERVANTES, MARIA G (RN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-8822
Mailing Address - Country:US
Mailing Address - Phone:518-489-3739
Mailing Address - Fax:
Practice Address - Street 1:593 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-2136
Practice Address - Country:US
Practice Address - Phone:518-489-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY525638163WH0200X, 163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care