Provider Demographics
NPI:1043083033
Name:NIDZIEKO, COURTNEY RAE
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:RAE
Last Name:NIDZIEKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 DOGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1313
Mailing Address - Country:US
Mailing Address - Phone:619-890-8567
Mailing Address - Fax:
Practice Address - Street 1:2145 DOGWOOD PL
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1313
Practice Address - Country:US
Practice Address - Phone:619-890-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula