Michelle Angela Cordova, RN, IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

66892 Issued in NM

Practice address

35 Taos Dr
Gallup, NM 87305

Phone

(425) 306-1689

NPI assigned

Mar 14, 2024

Last updated

Mar 14, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Michelle Angela Bentz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1265291074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3553",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873053553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 TAOS DR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "87305",
            "telephone_number": "425-306-1689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOVA",
        "first_name": "MICHELLE",
        "middle_name": "ANGELA",
        "credential": "RN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "NM",
            "license": "66892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "BENTZ",
            "middle_name": "ANGELA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard Donald Cooper, RN
• Lisa June Cope, RN, BSN, CCRN
• Randolph Leigh Copeland, M.D.
• Emma A Cordero, RN
• Edgar R Cordivin, MD
• Ripon Cordova, RN
• Debra Corman, RN
• Tara Cormier
• Mauricio Ernesto Corral
• Stacey Leigh Cortez

• Lactation Consultant (Registered Nurse) in Gallup, NM
• Providers in Gallup, NM by specialty
• Lactation Consultant (Registered Nurse) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.