Provider Demographics
NPI:1174061188
Name:RUPIPER, COURTNEY RAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:RAE
Last Name:RUPIPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:RAE
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1550 6TH ST.
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:IA
Mailing Address - Zip Code:51455
Mailing Address - Country:US
Mailing Address - Phone:712-830-4249
Mailing Address - Fax:
Practice Address - Street 1:1550 6TH ST,
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455
Practice Address - Country:US
Practice Address - Phone:712-655-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant