Provider Demographics
NPI:1588260574
Name:PRODAN, KOURTNI (CRNP)
Entity type:Individual
Prefix:
First Name:KOURTNI
Middle Name:
Last Name:PRODAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CLEMSON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1722
Mailing Address - Country:US
Mailing Address - Phone:309-256-9076
Mailing Address - Fax:
Practice Address - Street 1:501 BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:BRADDOCK
Practice Address - State:PA
Practice Address - Zip Code:15104-1856
Practice Address - Country:US
Practice Address - Phone:412-636-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily