Provider Demographics
NPI:1912453341
Name:CARDENAS HOLISTIC HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:CARDENAS HOLISTIC HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP
Authorized Official - Phone:940-473-9043
Mailing Address - Street 1:4506 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-4915
Mailing Address - Country:US
Mailing Address - Phone:940-473-9043
Mailing Address - Fax:940-552-2473
Practice Address - Street 1:1015 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3100
Practice Address - Country:US
Practice Address - Phone:940-552-5495
Practice Address - Fax:940-552-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130985363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty