Provider Demographics
NPI:1972083020
Name:CASE, COURTNEY NICOLE ANTOINETTE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:NICOLE ANTOINETTE
Last Name:CASE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:NICOLE ANTOINETTE
Other - Last Name:LUBICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 CO CO CT
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919-1932
Mailing Address - Country:US
Mailing Address - Phone:724-713-8862
Mailing Address - Fax:
Practice Address - Street 1:100 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8453
Practice Address - Country:US
Practice Address - Phone:919-650-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant