Provider Demographics
NPI:1962064436
Name:KLATT, COURTNEY F (FNP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:F
Last Name:KLATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:FAYE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1902 MEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-6140
Mailing Address - Country:US
Mailing Address - Phone:414-329-4979
Mailing Address - Fax:
Practice Address - Street 1:1902 MEAD AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6140
Practice Address - Country:US
Practice Address - Phone:414-329-4979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner