Active NPI
Andrea Cormier, PA
- Physician Assistant
- Albuquerque, NM
National Provider Identifier
1508994559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 97-PA24
- Practice address
- 719 San Mateo Blvd NE
Albuquerque, NM 87108-1434 - Phone
- (505) 265-5976
- NPI assigned
- Mar 1, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 97-PA24 | NM | Primary |
Addresses
Primary practice location
719 San Mateo Blvd NE
Albuquerque, NM 87108-1434
Mailing address
1617 Stanford Dr SE
Albuquerque, NM 87106-3308
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000S6401 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508994559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1617 STANFORD DR SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871063308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "719 SAN MATEO BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871081434",
"telephone_number": "505-265-5976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORMIER",
"first_name": "ANDREA",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "97-PA24",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000S6401",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.