| Doctor Name: | MRS. COURTNEY FEZZEY |
| NPI Number: | 1073935383 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4704268781 |
| Business Practice Address: | 39200 Garfield Rd Suite E Clinton Twp, MI - 480384095 |
| Business Phone Number: | 5862634010 |
| Business Fax Number: | |
| Mailing Address: | 927 Edgewood Dr, ROYAL OAK |
| State: | MI |
| Postal Code: | 480671795 |
| Phone Number: | 2487366562 |
| Fax Number: | |
| NPI Enumeration Date: | 01/07/2014 |
| NPI Last Update Date: | 09/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0222X |
| License Number: | 4704268781 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics, Critical Care |
| Taxonomy Definition: | |