Provider Demographics
NPI:1861685539
Name:HLAVINKA, COURTNEY A (APNP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:A
Last Name:HLAVINKA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:A
Other - Last Name:BARUTHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:2901 W. KK RIVER PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3660
Mailing Address - Country:US
Mailing Address - Phone:414-645-6000
Mailing Address - Fax:414-645-6354
Practice Address - Street 1:2901 W. KK RIVER PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3660
Practice Address - Country:US
Practice Address - Phone:414-645-6070
Practice Address - Fax:414-645-6354
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI144184363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner