Provider Demographics
NPI:1356951669
Name:GANDEE, COURTNEY MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:GANDEE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:VT
Mailing Address - Zip Code:05149-1301
Mailing Address - Country:US
Mailing Address - Phone:802-228-8867
Mailing Address - Fax:
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:VT
Practice Address - Zip Code:05149-1301
Practice Address - Country:US
Practice Address - Phone:802-228-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0050499163W00000X
VT101.0134625363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse