Healthcare Provider Details

I. General information

NPI: 1265656656
Provider Name (Legal Business Name): MARGUERITE LYNN CORDAHI-CRUZ CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN CORDAHI CFNP

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 RODEO RD SUITE B13
SANTA FE NM
87507-6503
US

IV. Provider business mailing address

1808 OTOWI RD
SANTA FE NM
87505-3301
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-0120
  • Fax:
Mailing address:
  • Phone: 505-984-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR21861
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: