Basic Information
| Provider Information | |||||||||
| NPI: | 1396725289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDOVA | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 N SANTA FE AVE | ||||||||
| Address2: | STE 2010 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731187532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052725555 | ||||||||
| FaxNumber: | 4052725517 | ||||||||
| Practice Location | |||||||||
| Address1: | 6201 N SANTA FE AVE | ||||||||
| Address2: | STE 2010 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731187532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052725555 | ||||||||
| FaxNumber: | 4052725517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R0063105 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.