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General NPI Number Information
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NPI Number | 1124281381
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Entity Type | Individual
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Provider Name | CRYSTAL D CARDWELL MD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 2220 GRANDE BLVD SE SUITE B
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City | RIO RANCHO
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State | NM
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Zip | 87124
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Country | US
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Telephone | 505-892-0402
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Fax | 304-938-0572
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Provider Business Mailing Address
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Address Line | 2220 GRANDE BLVD SE SUITE B
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City | RIO RANCHO
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State | NM
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Zip | 87124
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Country | US
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Telephone | 505-892-0402
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Fax | 304-938-0572
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12122
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2012-0030
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 65713
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License Number State | AZ
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