Provider Demographics
NPI:1356595052
Name:CORDOVA, CECILIA J (CNM, RN, ARNP)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:J
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:CNM, RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 RAVENNA AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7025
Mailing Address - Country:US
Mailing Address - Phone:206-522-9063
Mailing Address - Fax:
Practice Address - Street 1:6215 RAVENNA AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7025
Practice Address - Country:US
Practice Address - Phone:206-522-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003031367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife