Provider Demographics
NPI:1336168970
Name:COURTNEY, VIVIAN M (RN)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:M
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7919 WESLEY CHAPEL RD NE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9737
Mailing Address - Country:US
Mailing Address - Phone:740-743-3216
Mailing Address - Fax:740-743-3216
Practice Address - Street 1:7919 WESLEY CHAPEL RD NE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783-9737
Practice Address - Country:US
Practice Address - Phone:740-743-3216
Practice Address - Fax:740-743-3216
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 232014163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2455178Medicaid