Healthcare Provider Details

I. General information

NPI: 1841688389
Provider Name (Legal Business Name): CORDES LAKES MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20172 E STAGECOACH TRL
MAYER AZ
86333-2357
US

IV. Provider business mailing address

15029 N THOMPSON PEAK PKWY STE B111-438
SCOTTSDALE AZ
85260-2217
US

V. Phone/Fax

Practice location:
  • Phone: 928-772-1673
  • Fax: 602-218-4443
Mailing address:
  • Phone: 623-239-8534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3224
License Number StateAZ

VIII. Authorized Official

Name: CINDY M BROWN
Title or Position: OWNER
Credential: FNP-C
Phone: 928-772-1673