Provider Demographics
NPI:1811777048
Name:DOAK, COURTNEY MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:DOAK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 CRESTWAY DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6146
Mailing Address - Country:US
Mailing Address - Phone:330-842-3550
Mailing Address - Fax:
Practice Address - Street 1:4611 CRESTWAY DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6146
Practice Address - Country:US
Practice Address - Phone:330-842-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF09231001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty