Basic Information
| Provider Information | |||||||||
| NPI: | 1144891391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUTABAZI | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | WOLF | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN, MSN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 CENTER ST STE A | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514397878 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1610 CENTER ST STE A | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514397878 | ||||||||
| FaxNumber: | 2514329013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2021 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 1-63822 | AL | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.