Provider Demographics
NPI:1093557035
Name:SMITH, COURTNEY ANN (LM, CPM)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANN
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:812 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:WI
Mailing Address - Zip Code:54421-9567
Mailing Address - Country:US
Mailing Address - Phone:715-897-4197
Mailing Address - Fax:
Practice Address - Street 1:812 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:WI
Practice Address - Zip Code:54421-9567
Practice Address - Country:US
Practice Address - Phone:715-897-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife