Individual
COLLEEN COURTNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12500 AURORA DR, PLEASANT PRAIRIE, WI 53158-1227
(262) 857-5400
Mailing address
1723 CHERRY CT, LAKE VILLA, IL 60046-5774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5156-023
WI
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100103632
—
WI
Enumeration date
02/12/2020
Last updated
02/01/2024
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