Provider Demographics
NPI:1356603450
Name:DODRILL, COURTNEY SUZANNE (CNM, FNP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:SUZANNE
Last Name:DODRILL
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:SUZANNE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1249 SUNCREST TOWNE CENTRE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-599-6353
Mailing Address - Fax:304-598-3608
Practice Address - Street 1:1249 SUNCREST TOWNE CENTRE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-6353
Practice Address - Fax:304-598-3608
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRN84192367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025477Medicaid