Provider Demographics
NPI:1386329308
Name:SHOEMAKER, COURTNEY HOLDEN (RDCS (AE, PE))
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:HOLDEN
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:RDCS (AE, PE)
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:HOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDCS
Mailing Address - Street 1:812 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4017
Mailing Address - Country:US
Mailing Address - Phone:574-238-8092
Mailing Address - Fax:
Practice Address - Street 1:812 S 7TH ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4017
Practice Address - Country:US
Practice Address - Phone:574-238-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program