1639501703 NPI number — COURTNEY ANN BOHN CNM

Table of content: BRIAN RICKS (NPI 1386085843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639501703 NPI number — COURTNEY ANN BOHN CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOHN
Provider First Name:
COURTNEY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SLATON
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639501703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11675 IRONWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNESBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17268-9715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-215-1369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11675 IRONWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17268-9715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-215-1369
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  26NR14175200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN598135 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 26NJ00464600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP013578 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 25ME00053501 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 25ME00053500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: MW010318 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102938081 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".