Provider Demographics
NPI:1043755960
Name:WARE, COURTNAY
Entity Type:Individual
Prefix:
First Name:COURTNAY
Middle Name:
Last Name:WARE
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 1:49 W HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-2408
Mailing Address - Country:US
Mailing Address - Phone:248-825-5902
Mailing Address - Fax:
Practice Address - Street 1:49 W HAYES AVE
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-2408
Practice Address - Country:US
Practice Address - Phone:248-825-5902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-01
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other