Basic Information
Provider Information | |||||||||
NPI: | 1184888216 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COURTICE | ||||||||
FirstName: | MARIAN | ||||||||
MiddleName: | HENRY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | N.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX A D | ||||||||
Address2: |   | ||||||||
City: | YUBA CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 959921396 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5307513769 | ||||||||
FaxNumber: | 5307511237 | ||||||||
Practice Location | |||||||||
Address1: | 680 COHASSET RD | ||||||||
Address2: |   | ||||||||
City: | CHICO | ||||||||
State: | CA | ||||||||
PostalCode: | 959262213 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5303424395 | ||||||||
FaxNumber: | 5308942325 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2008 | ||||||||
LastUpdateDate: | 07/01/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 096007527N7 WHCNP-PP | OR | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
ID | Type | State | Issuer | Description | 2779 | 01 | CA | LICENSE | OTHER |