Provider Demographics
NPI:1700307337
Name:CARDENAS, MARIA C (PSYCH NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:PSYCH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:ORDWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81063-1031
Mailing Address - Country:US
Mailing Address - Phone:719-469-7468
Mailing Address - Fax:
Practice Address - Street 1:101 W 9TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4103
Practice Address - Country:US
Practice Address - Phone:719-583-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999946363LP0808X
CO0169073163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health