Provider Demographics
NPI:1184888216
Name:COURTICE, MARIAN HENRY (NP)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:HENRY
Last Name:COURTICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX A D
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-1396
Mailing Address - Country:US
Mailing Address - Phone:530-751-3769
Mailing Address - Fax:530-751-1237
Practice Address - Street 1:680 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2213
Practice Address - Country:US
Practice Address - Phone:530-342-4395
Practice Address - Fax:530-894-2325
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096007527N7 WHCNP-PP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2779OtherLICENSE
ORR147277Medicare PIN