Provider Demographics
NPI:1831856616
Name:SEIDENBERG, COURTNEY M (MSN, APN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:SEIDENBERG
Suffix:
Gender:F
Credentials:MSN, APN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ROUTE 73 S STE 210
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4133
Mailing Address - Country:US
Mailing Address - Phone:856-399-1010
Mailing Address - Fax:
Practice Address - Street 1:750 ROUTE 73 S STE 210
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4133
Practice Address - Country:US
Practice Address - Phone:856-399-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01234700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner