Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99169 | TX |
NPI | 1154660587 |
---|---|
Provider Name | Ms. Jennifer Courtney |
First Address | Marshall, TX 75671-0952 |
Second Address | Marshall, TX 75670-5262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2013 |
Last Update Date | 05/02/2013 |