Provider Demographics
NPI:1750679114
Name:BEAUDETTE, COURTNEY R (APNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
Last Name:BEAUDETTE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:R
Other - Last Name:RASHLEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7238
Practice Address - Street 1:2020 RIVERSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2300
Practice Address - Country:US
Practice Address - Phone:920-433-9920
Practice Address - Fax:920-433-9927
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4439-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0611063OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS