Provider Demographics
NPI:1346072782
Name:GAVELEK, COURTNEY PAIGE (CAPRC1)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:PAIGE
Last Name:GAVELEK
Suffix:
Gender:F
Credentials:CAPRC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-7268
Mailing Address - Country:US
Mailing Address - Phone:812-799-6212
Mailing Address - Fax:
Practice Address - Street 1:2835 THOMPSON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-7268
Practice Address - Country:US
Practice Address - Phone:812-799-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCAPRC1-5884172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker