Provider Demographics
NPI:1558655894
Name:BUCHHOLZ, CORTNEY RUTH (RN)
Entity Type:Individual
Prefix:MISS
First Name:CORTNEY
Middle Name:RUTH
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1614
Mailing Address - Country:US
Mailing Address - Phone:218-834-6174
Mailing Address - Fax:218-834-4015
Practice Address - Street 1:414 1ST AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1614
Practice Address - Country:US
Practice Address - Phone:218-834-6174
Practice Address - Fax:218-834-4015
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN353079310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility