Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 25MB10834400 | NJ |
NPI | 1992155758 |
---|---|
Provider Name | Katelyn Courtney |
First Address | Stratford, NJ 08084-1327 |
Second Address | Stratford, NJ 08084-1327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2016 |
Last Update Date | 06/07/2020 |