Provider Demographics
NPI:1215248596
Name:PRASCH, COURTNEY E (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:PRASCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8376 COUNTY ROAD T
Mailing Address - Street 2:
Mailing Address - City:GLENBEULAH
Mailing Address - State:WI
Mailing Address - Zip Code:53023-1512
Mailing Address - Country:US
Mailing Address - Phone:619-599-8068
Mailing Address - Fax:
Practice Address - Street 1:2414 KOHLER MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3129
Practice Address - Country:US
Practice Address - Phone:920-457-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2610-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant