Provider Demographics
NPI:1295413391
Name:ISSIS-BANUELOS, COURTNEY (CRNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ISSIS-BANUELOS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:L
Other - Last Name:ISSIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 MEDICAL WEST WAY STE 410
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-7082
Mailing Address - Country:US
Mailing Address - Phone:205-481-8570
Mailing Address - Fax:
Practice Address - Street 1:5000 MEDICAL WEST WAY STE 410
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-7082
Practice Address - Country:US
Practice Address - Phone:205-481-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-162638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily