Healthcare Provider Details

I. General information

NPI: 1124281381
Provider Name (Legal Business Name): CRYSTAL DAWN CARDWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BROADMOOR BLVD NE
RIO RANCHO NM
87144-2100
US

IV. Provider business mailing address

3001 BROADMOOR BLVD NE
RIO RANCHO NM
87144-2100
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-7000
  • Fax: 304-938-0572
Mailing address:
  • Phone: 505-994-7000
  • Fax: 304-938-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number65713
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2012-0030
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12122
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2012-0030
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: