Provider Demographics
NPI:1215060447
Name:SAND, COURTNEY DEE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DEE
Last Name:SAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1152
Mailing Address - Country:US
Mailing Address - Phone:209-484-2903
Mailing Address - Fax:
Practice Address - Street 1:2309 C ST SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3707
Practice Address - Country:US
Practice Address - Phone:319-365-6411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program