Healthcare Provider Details

I. General information

NPI: 1477339125
Provider Name (Legal Business Name): CORDERO PIERRE ABDULLAH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9252 COUNTY ROAD 408A
GRANDVIEW TX
76050-4181
US

IV. Provider business mailing address

3333 GREEN BAY RD
NORTH CHICAGO IL
60064-3037
US

V. Phone/Fax

Practice location:
  • Phone: 214-886-9280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1204499
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024195696
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041.549224
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number970105
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number970105
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: