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General NPI Number Information
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NPI Number | 1043697923
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Entity Type | Individual
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Provider Name | COURTNEY ANNE NESTOR MS, AT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 11301 COMMERCE DR STE B
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City | ALLENDALE
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State | MI
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Zip | 49401-8200
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Country | US
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Telephone | 616-895-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 637 CLAYTON AVE NW
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City | WALKER
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State | MI
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Zip | 49534-3511
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Country | US
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Telephone | 313-452-1023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001658
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License Number State | MI
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