Healthcare Provider Details

I. General information

NPI: 1700617248
Provider Name (Legal Business Name): COURTNEY JEAN LUDEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY BISHOP NP

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 S MAIN ST
WARSAW NY
14569-1571
US

IV. Provider business mailing address

300 WEST AVE
BROCKPORT NY
14420-1118
US

V. Phone/Fax

Practice location:
  • Phone: 585-228-1195
  • Fax:
Mailing address:
  • Phone: 585-637-3905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354307
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: