Provider Demographics
NPI:1538766514
Name:COURDIN-WHITSON, MARTHA LORRAINE
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LORRAINE
Last Name:COURDIN-WHITSON
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 1:386 CAUDILL WAY
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8686
Mailing Address - Country:US
Mailing Address - Phone:417-348-8655
Mailing Address - Fax:
Practice Address - Street 1:386 CAUDILL WAY
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8686
Practice Address - Country:US
Practice Address - Phone:417-348-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020025764363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner