Provider Demographics
NPI:1831472927
Name:COURTEMANCHE, EDWARD RAYMOND (MSN ANP-BC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:RAYMOND
Last Name:COURTEMANCHE
Suffix:
Gender:M
Credentials:MSN ANP-BC
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Mailing Address - Street 1:6889 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327
Mailing Address - Country:US
Mailing Address - Phone:248-666-5200
Mailing Address - Fax:248-666-5069
Practice Address - Street 1:6889 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:248-666-5200
Practice Address - Fax:248-666-5069
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704221729163WX0106X, 363LA2200X
OHRN335752163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health