Provider Demographics
NPI:1245902741
Name:DECOURSEY, CAITLIN EILEEN (RN)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:EILEEN
Last Name:DECOURSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:EILEEN
Other - Last Name:DE COURSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2311 E OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2443
Mailing Address - Country:US
Mailing Address - Phone:949-878-1862
Mailing Address - Fax:
Practice Address - Street 1:2311 E OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-2443
Practice Address - Country:US
Practice Address - Phone:949-878-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95061105163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse