Basic Information
| Provider Information | |||||||||
| NPI: | 1548995186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHON | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, FNP, AGACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 N CARR ST | ||||||||
| Address2: | |||||||||
| City: | MEBANE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27302 | ||||||||
| CountryCode: | UM | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849741000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2022 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5016880 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163WC0200X | 279115 | NC | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.