Provider Demographics
NPI:1043737703
Name:CROOKER, COURTNEY LEIGH (LPN)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:LEIGH
Last Name:CROOKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MORELAND DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAMS
Mailing Address - State:NY
Mailing Address - Zip Code:14812-9101
Mailing Address - Country:US
Mailing Address - Phone:607-684-1478
Mailing Address - Fax:
Practice Address - Street 1:9053 STATE ROUTE 53
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-8008
Practice Address - Country:US
Practice Address - Phone:607-622-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301598164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty