Basic Information
| Provider Information | |||||||||
| NPI: | 1285139675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COURTRIGHT | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | GRACE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| OtherLastName: | GIVLER | ||||||||
| OtherFirstName: | MARTHA | ||||||||
| OtherMiddleName: | GRACE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | SSB-6 | ||||||||
| Address2: | 400 E 3RD ST | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558051951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187868364 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11134 N STATE ROAD 77 | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548435325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156345505 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7257320 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.