Provider Demographics
NPI:1487863759
Name:RANALLO, COURTNEY DAWN (MD)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:DAWN
Last Name:RANALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:DAWN
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10005 KANE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:405-370-9515
Mailing Address - Fax:
Practice Address - Street 1:800 MARSHALL ST
Practice Address - Street 2:SLOT 512-19A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3510
Practice Address - Country:US
Practice Address - Phone:501-364-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program