Provider Demographics
NPI:1568400695
Name:DANNER, CORTNEY G (PNP)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:G
Last Name:DANNER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ARDEN LN STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2995
Mailing Address - Country:US
Mailing Address - Phone:803-980-7337
Mailing Address - Fax:803-980-2226
Practice Address - Street 1:724 ARDEN LN STE 100
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2995
Practice Address - Country:US
Practice Address - Phone:803-980-7337
Practice Address - Fax:803-980-2226
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20895208000000X, 363LP0200X
NC5001611363L00000X
NC38354363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592657Medicare PIN
Q69633Medicare UPIN