Individual
COURTNEY BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
465 N PERRY ST, JOHNSTOWN, NY 12095-1014
(518) 736-3908
Mailing address
121 OPPORTUNITY DR, SCHOHARIE, NY 12157-2912
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
321752
NY
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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