Provider Demographics
NPI:1669144424
Name:MUNDY, COURTNEY MARIE (CNM)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:MUNDY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9176 WINESBURG RD
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OH
Mailing Address - Zip Code:44624-9437
Mailing Address - Country:US
Mailing Address - Phone:330-359-0580
Mailing Address - Fax:
Practice Address - Street 1:9176 WINESBURG RD
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OH
Practice Address - Zip Code:44624-9437
Practice Address - Country:US
Practice Address - Phone:330-359-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
OHCNM07325367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2206779Medicaid