Provider Demographics
NPI:1073882742
Name:DIETZ, COURTNEY STEWART (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:STEWART
Last Name:DIETZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:BETH
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:MEDEXPRESS URGENT CARE 11603 MIDLOTHIAN TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:304-256-3027
Mailing Address - Fax:304-256-8670
Practice Address - Street 1:MEDEXPRESS URGENT CARE 11603 MIDLOTHIAN TURNPIKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-378-3739
Practice Address - Fax:804-594-1926
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003661363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical