Dulce Rubi Mara Cordova, CNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11957 Issued in MN

Practice address

902 White St
Jackson, MN 56143-1473

Phone

(507) 350-1219

NPI assigned

Aug 19, 2024

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 19, 2024.

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1497587406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 WHITE ST",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431473",
            "telephone_number": "507-350-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 WHITE ST",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431473",
            "telephone_number": "507-350-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOVA",
        "first_name": "DULCE RUBI",
        "middle_name": "MARA",
        "credential": "CNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "11957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Lee Burud-Kolander, SLP
• Lisbeth Melissa Castillo
• Chad Brown, D.D.S., P.C.
• Deborah Davis Christopher, DDS
• City of Jackson
• Brittany Ann Dahl
• David M Kruse OD PA
• Des Moines Valley Health and Human Services
• Des Moines Valley Health and Human Services
• Desmoines Valley BHS

• All providers in Jackson, MN
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.