Provider Demographics
NPI:1982016127
Name:MAULE, CORDELL LAFERNE (NP)
Entity Type:Individual
Prefix:
First Name:CORDELL
Middle Name:LAFERNE
Last Name:MAULE
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 1:11607 220TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1624
Mailing Address - Country:US
Mailing Address - Phone:718-527-3477
Mailing Address - Fax:
Practice Address - Street 1:220 E 42ND ST
Practice Address - Street 2:FL 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5831
Practice Address - Country:US
Practice Address - Phone:646-453-6900
Practice Address - Fax:646-524-8323
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305590-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health