Provider Demographics
NPI:1952793853
Name:SCHANTZEN, COURTNEY (MSN, APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SCHANTZEN
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10081 DOGWOOD ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-5281
Mailing Address - Country:US
Mailing Address - Phone:763-783-3722
Mailing Address - Fax:
Practice Address - Street 1:10081 DOGWOOD ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-5281
Practice Address - Country:US
Practice Address - Phone:763-783-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP3722363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCNP3722OtherAPRN LICENSE
MNR215239-6OtherRN