Provider Demographics
NPI:1699012039
Name:COURTNEY, JENNIE L (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:L
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3570
Mailing Address - Country:US
Mailing Address - Phone:509-526-1965
Mailing Address - Fax:509-529-5842
Practice Address - Street 1:450 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3570
Practice Address - Country:US
Practice Address - Phone:509-526-1965
Practice Address - Fax:509-529-5842
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00093521163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse