Provider Demographics
NPI:1508431792
Name:CORTEZ, FATIMA MABALOT (NP)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:MABALOT
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9479
Mailing Address - Country:US
Mailing Address - Phone:907-738-3173
Mailing Address - Fax:
Practice Address - Street 1:1728 S PENINSULA RD
Practice Address - Street 2:
Practice Address - City:EAST JORDAN
Practice Address - State:MI
Practice Address - Zip Code:49727-9410
Practice Address - Country:US
Practice Address - Phone:231-536-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704361503163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse