Provider Demographics
NPI:1376288373
Name:STATER, KOURTNEE ANN NICOLE (CERTIFIED BIRTHDOULA)
Entity Type:Individual
Prefix:
First Name:KOURTNEE
Middle Name:ANN NICOLE
Last Name:STATER
Suffix:
Gender:F
Credentials:CERTIFIED BIRTHDOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2164
Mailing Address - Country:US
Mailing Address - Phone:805-668-9912
Mailing Address - Fax:
Practice Address - Street 1:516 ORCHID LN
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2164
Practice Address - Country:US
Practice Address - Phone:805-668-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9404-13374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula