Provider Demographics
NPI:1972083020
Name:CASE, COURTNEY NICOLE ANTOINETTE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:NICOLE ANTOINETTE
Last Name:CASE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:NICOLE ANTOINETTE
Other - Last Name:LUBICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27631 COUNTY ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3348
Mailing Address - Country:US
Mailing Address - Phone:724-713-8862
Mailing Address - Fax:
Practice Address - Street 1:1001 WEST ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9703
Practice Address - Country:US
Practice Address - Phone:315-493-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant