Healthcare Provider Details

I. General information

NPI: 1861685539
Provider Name (Legal Business Name): COURTNEY A. HLAVINKA APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY A. BARUTHA APNP

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E GENEVA SQ
LAKE GENEVA WI
53147-9695
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-249-5000
  • Fax: 262-249-7142
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number144184
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: