Provider Demographics
NPI:1902536238
Name:MORTENSEN, COURTNEY LEMON (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEMON
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 W FRYE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-821-3622
Mailing Address - Fax:
Practice Address - Street 1:2545 W FRYE RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6273
Practice Address - Country:US
Practice Address - Phone:480-821-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant