Healthcare Provider Details

I. General information

NPI: 1043141237
Provider Name (Legal Business Name): COURTNEY NURSE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 AIRPORT RD NW STE 130
ROANOKE VA
24012-1607
US

IV. Provider business mailing address

17230 133RD AVE APT 4E
JAMAICA NY
11434-3916
US

V. Phone/Fax

Practice location:
  • Phone: 540-516-4098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: