Provider Demographics
NPI:1538778873
Name:COURTWAY, ERIN MARIE (APRN)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MARIE
Last Name:COURTWAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:ROUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3889 N STEELE BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5414
Mailing Address - Country:US
Mailing Address - Phone:479-301-5985
Mailing Address - Fax:
Practice Address - Street 1:1706 E JOYCE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5249
Practice Address - Country:US
Practice Address - Phone:479-301-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR125831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily