Provider Demographics
NPI:1801498431
Name:MISKELL, COURTNEY FAY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:FAY
Last Name:MISKELL
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:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:DRAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58736-0075
Mailing Address - Country:US
Mailing Address - Phone:701-720-0483
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH ST W APT B103
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1052
Practice Address - Country:US
Practice Address - Phone:701-500-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant