Individual
COURTNEY L CONVERSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
535 S BURDICK ST STE 256, KALAMAZOO, MI 49007-6112
(269) 290-1901
(269) 290-1913
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004349
MI
363AS0400X
Surgical Physician Assistant
5601004349
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417961137
BCBS - BRONSON
MI
05
—
1699743872
—
MI
Enumeration date
03/14/2006
Last updated
06/01/2022
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