Provider Demographics
NPI:1144891391
Name:MUTABAZI, COURTNEY WOLF (RN, MSN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:WOLF
Last Name:MUTABAZI
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 CENTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1543
Mailing Address - Country:US
Mailing Address - Phone:251-439-7878
Mailing Address - Fax:
Practice Address - Street 1:1610 CENTER ST STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1543
Practice Address - Country:US
Practice Address - Phone:251-439-7878
Practice Address - Fax:251-432-9013
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-63822163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management