Provider Demographics
NPI:1023357282
Name:ELLIS, COURTNEY KAYE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KAYE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4218
Mailing Address - Country:US
Mailing Address - Phone:949-533-3036
Mailing Address - Fax:949-716-0772
Practice Address - Street 1:26 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4218
Practice Address - Country:US
Practice Address - Phone:949-533-3036
Practice Address - Fax:949-716-0772
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife