Healthcare Provider Details

I. General information

NPI: 1962470096
Provider Name (Legal Business Name): DONNA COURTNEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CENTER ST
CONNEAUT OH
44030-3062
US

IV. Provider business mailing address

4000 E CENTER ST
CONNEAUT OH
44030-3062
US

V. Phone/Fax

Practice location:
  • Phone: 440-593-3266
  • Fax:
Mailing address:
  • Phone: 440-593-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN164798
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: