Provider Demographics
NPI:1659751824
Name:AKE, COURTNEY (LPN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:AKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9504
Mailing Address - Country:US
Mailing Address - Phone:315-247-9394
Mailing Address - Fax:
Practice Address - Street 1:6528 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9504
Practice Address - Country:US
Practice Address - Phone:315-247-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316642-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse