Provider Demographics
NPI:1356615462
Name:COURTNEY, PAMELA MARIE
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:KEESEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944-3701
Mailing Address - Country:US
Mailing Address - Phone:518-834-9909
Mailing Address - Fax:
Practice Address - Street 1:300 CHAZY LAKE RD
Practice Address - Street 2:
Practice Address - City:SARANAC
Practice Address - State:NY
Practice Address - Zip Code:12981-3232
Practice Address - Country:US
Practice Address - Phone:518-293-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY524943-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse