Provider Demographics
NPI:1356140768
Name:DOREMUS, COURTNEY L
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:DOREMUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NE
Mailing Address - Zip Code:68640-3106
Mailing Address - Country:US
Mailing Address - Phone:308-940-3290
Mailing Address - Fax:
Practice Address - Street 1:422 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NE
Practice Address - Zip Code:68640-3106
Practice Address - Country:US
Practice Address - Phone:308-940-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider