Healthcare Provider Details

I. General information

NPI: 1598131468
Provider Name (Legal Business Name): CHERI CORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 PARKER BLVD STE 350
PUEBLO CO
81008-2213
US

IV. Provider business mailing address

7951 E MAPLEWOOD AVE STE 300
GREENWOOD VILLAGE CO
80111-4726
US

V. Phone/Fax

Practice location:
  • Phone: 719-296-6000
  • Fax: 719-545-1146
Mailing address:
  • Phone: 303-930-7800
  • Fax: 303-930-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0992037-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0182096
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: