Provider Demographics
NPI:1639501703
Name:BOHN, COURTNEY ANN (CNM)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:BOHN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANN
Other - Last Name:SLATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:11675 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-9715
Mailing Address - Country:US
Mailing Address - Phone:862-215-1369
Mailing Address - Fax:
Practice Address - Street 1:11675 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-9715
Practice Address - Country:US
Practice Address - Phone:862-215-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14175200163W00000X
PARN598135163W00000X
NJ26NJ00464600363LF0000X
PASP013578363LF0000X
NJ25ME00053501367A00000X
NJ25ME00053500367A00000X
PAMW010318367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102938081Medicaid