Provider Demographics
NPI:1295494250
Name:MARSH, COURTNEY NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NICOLE
Last Name:MARSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19777 N 76TH ST APT 2144
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4569
Mailing Address - Country:US
Mailing Address - Phone:480-766-1097
Mailing Address - Fax:
Practice Address - Street 1:1450 S DOBSON RD STE A200
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4742
Practice Address - Country:US
Practice Address - Phone:480-629-5167
Practice Address - Fax:480-969-0630
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant