Provider Demographics
NPI:1972859452
Name:CORTEZ, COURTNEY B
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:B
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:B
Other - Last Name:OSTACHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12400 N MERIDIAN STE 100
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-559-3320
Mailing Address - Fax:
Practice Address - Street 1:12400 N MERIDIAN STE 100
Practice Address - Street 2:SUITE 500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-559-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004263A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COR1-0437-0895OtherNATIONAL CERTIFICATION CORPORATION - WHNP - BC
IN71004263AOtherAPN LICENSE
INP01456971OtherMEDICARE RR
IN201151310Medicaid
IN28162939AOtherRN LICENSE
INP01456971OtherRR MEDICARE
IN71004263AMedicaid
IN266180413Medicare PIN