1164445664 NPI number — DONNA MAE CORDES CRNP

Table of content: DONNA MAE CORDES CRNP (NPI 1164445664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164445664 NPI number — DONNA MAE CORDES CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDES
Provider First Name:
DONNA
Provider Middle Name:
MAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164445664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 PIEDMONT CUTOFF
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35903-2708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-492-0131
Provider Business Mailing Address Fax Number:
256-494-6000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 NOBLE ST # 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNISTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36201-5698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-770-4083
Provider Business Practice Location Address Fax Number:
256-405-4997
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  1044510 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 128480 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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