Provider Demographics
NPI:1326744327
Name:KANTOLA, COURTNEY NICHOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NICHOLE
Last Name:KANTOLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:NICHOLE
Other - Last Name:TRAUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:10101 PORKY RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:PA
Mailing Address - Zip Code:16401-9712
Mailing Address - Country:US
Mailing Address - Phone:814-397-5582
Mailing Address - Fax:
Practice Address - Street 1:118 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1502
Practice Address - Country:US
Practice Address - Phone:814-877-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026904363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily