Basic Information
| Provider Information | |||||||||
| NPI: | 1992148738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESSERLY | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NIBBE | ||||||||
| OtherFirstName: | COURTNEY | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4194 LEXINGTON AVE N | ||||||||
| Address2: | |||||||||
| City: | SHOREVIEW | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551266106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514835461 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4194 LEXINGTON AVE N | ||||||||
| Address2: | |||||||||
| City: | SHOREVIEW | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551266106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514835461 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2013 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 65606 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-43539 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.