Provider Demographics
NPI:1104932920
Name:MAYHEW, COURTNEY ROSE (MS, APNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ROSE
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:MS, APNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ROSE
Other - Last Name:CHARLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4345 KEATING TER
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1563
Mailing Address - Country:US
Mailing Address - Phone:608-577-7990
Mailing Address - Fax:
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2703363LA2200X
WI2005005716363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology