Provider Demographics
NPI:1912684549
Name:AUSTIN, COURTNEY (APRN-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4212 INGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6663
Mailing Address - Country:US
Mailing Address - Phone:517-960-4315
Mailing Address - Fax:
Practice Address - Street 1:4212 INGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-6663
Practice Address - Country:US
Practice Address - Phone:517-960-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330010208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice