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NPI Code Detail

MEDICARE: CYNTHIA JANE CORDOVA LADC

MEDICARE: CYNTHIA JANE CORDOVA LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor690NE

General Provider Information

NPI Number : 1972800506
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA JANE CORDOVA LADC
Provider Business Mailing Address
First Line : 120 WEDGEWOOD DR
Second Line :
City : LINCOLN
State : NE
Zip : 68510-2431
Country : US
Telephone Number : 402-441-3756
Fax Number : 402-441-3770
Provider Business Practice Location Address
First Line : 120 WEDGEWOOD DR
Second Line :
City : LINCOLN
State : NE
Zip : 68510-2431
Country : US
Telephone Number : 402-441-3756
Fax Number : 402-441-3770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2011
Last Update Date : 02/17/2011

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Directions to “ CYNTHIA JANE CORDOVA LADC” Practice Location

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