Organization Name: | MARTHA B. CORDOVA RN ARNP PLC |
NPI Number: | 1891740791 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARTHA CORDOVA (PRESIDENT) |
Mailing Address: | 2148 N 381 Wetumka |
State: | OK US |
Postal Code: | 748836101 |
Phone Number: | 4054525155 |
Fax Number: | 4054525155 |
NPI Enumeration Date: | 05/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R63105 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |