Provider Demographics
NPI:1750092086
Name:REARDON, COURTNEY NICOLE (RN)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:NICOLE
Last Name:REARDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:NICOLE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:411 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4801
Mailing Address - Country:US
Mailing Address - Phone:716-487-2273
Mailing Address - Fax:716-484-9584
Practice Address - Street 1:411 W 3RD ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4801
Practice Address - Country:US
Practice Address - Phone:716-487-2273
Practice Address - Fax:716-484-9584
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY82414501163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health