Provider Demographics
NPI:1952881435
Name:BUMBALOUGH, COURTNEY N (FNP-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:N
Last Name:BUMBALOUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 DIRECTORS ROW STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4936
Mailing Address - Country:US
Mailing Address - Phone:317-941-7338
Mailing Address - Fax:317-969-6727
Practice Address - Street 1:2445 DIRECTORS ROW STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4936
Practice Address - Country:US
Practice Address - Phone:317-941-7338
Practice Address - Fax:317-969-6727
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF07180702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily