Healthcare Provider Details

I. General information

NPI: 1366864779
Provider Name (Legal Business Name): CYNTHIA CORTES PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OSLO CIR
BIRMINGHAM AL
35211-5965
US

IV. Provider business mailing address

2209 MOUNTAIN CREEK TRL
HOOVER AL
35226-1819
US

V. Phone/Fax

Practice location:
  • Phone: 205-944-3944
  • Fax:
Mailing address:
  • Phone: 205-726-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-032031
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: