Healthcare Provider Details

I. General information

NPI: 1891740791
Provider Name (Legal Business Name): MARTHA B. CORDOVA RN ARNP PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 N 381
WETUMKA OK
74883-6101
US

IV. Provider business mailing address

2148 N 381
WETUMKA OK
74883-6101
US

V. Phone/Fax

Practice location:
  • Phone: 405-452-5155
  • Fax: 405-452-5155
Mailing address:
  • Phone: 405-452-5155
  • Fax: 405-452-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR63105
License Number StateOK

VIII. Authorized Official

Name: MS. MARTHA CORDOVA
Title or Position: PRESIDENT
Credential: RN, ARNP, NP-C
Phone: 405-452-5155