Healthcare Provider Details

I. General information

NPI: 1770788986
Provider Name (Legal Business Name): CORTNEY JEAN NEMETH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S. 2ND
EDMORE MI
48829
US

IV. Provider business mailing address

2320 ELEEN RD
SIX LAKES MI
48886-9610
US

V. Phone/Fax

Practice location:
  • Phone: 989-427-0165
  • Fax:
Mailing address:
  • Phone: 616-824-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703085016
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: