Provider Demographics
NPI:1669860250
Name:MANN, COURTNEY MELISSA (CRNA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MELISSA
Last Name:MANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 BERRYMEADE LN
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-3729
Mailing Address - Country:US
Mailing Address - Phone:580-222-6916
Mailing Address - Fax:
Practice Address - Street 1:3169 BERRYMEADE LN
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-3729
Practice Address - Country:US
Practice Address - Phone:580-222-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127401367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered