Provider Demographics
NPI:1306541222
Name:PICKAR, COURTNEY SUE (RNC-OB, ACNS-BC,)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SUE
Last Name:PICKAR
Suffix:
Gender:F
Credentials:RNC-OB, ACNS-BC,
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:SUE
Other - Last Name:THEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 SUNKIST AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2107
Mailing Address - Country:US
Mailing Address - Phone:414-405-9148
Mailing Address - Fax:
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-447-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133218364SP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP1700XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerinatal