Healthcare Provider Details

I. General information

NPI: 1013155258
Provider Name (Legal Business Name): JONATHAN ASA CADE RN, MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87111-3559
US

IV. Provider business mailing address

3825 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87111-3559
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-8575
  • Fax:
Mailing address:
  • Phone: 505-292-8575
  • Fax: 505-292-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA03615
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01942
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN259257
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: