Provider Demographics
NPI:1730343062
Name:ESTALA, COURTNEY M (PA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:ESTALA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-8701
Mailing Address - Fax:517-884-8787
Practice Address - Street 1:4660 S HAGADORN RD STE 500
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6804
Practice Address - Country:US
Practice Address - Phone:517-884-8701
Practice Address - Fax:517-884-8787
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2023-06-26
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Provider Licenses
StateLicense IDTaxonomies
MI5601005417363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant