Provider Demographics
NPI:1700613049
Name:COURTNEY, MARIAH (NP)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 CHARDONNAY RDG
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1732
Mailing Address - Country:US
Mailing Address - Phone:631-617-0226
Mailing Address - Fax:
Practice Address - Street 1:661 CHARDONNAY RDG
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1732
Practice Address - Country:US
Practice Address - Phone:631-617-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH433520163WG0000X
OH2023062484363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice