Provider Demographics
NPI:1225161763
Name:HOWELL, COURTNEY OCTAVE (PNP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:OCTAVE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 S DOBSON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4768
Mailing Address - Country:US
Mailing Address - Phone:480-412-7120
Mailing Address - Fax:480-412-5611
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-412-7120
Practice Address - Fax:480-412-5611
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN119828163W00000X
AZAP2628363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ198698Medicaid
AZZ145567Medicare PIN