COURTNEY SLOCUM PETERSEN (NPI# 1730184375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730184375 |
| Entity Type | Individual |
| Full Name | COURTNEY SLOCUM PETERSEN |
| Credential | PA-C |
| Practice Address |
750 Washington St # 178 Tufts Medical Center Boston MA 02111-1526 |
| Mailing Address |
57 E Concord St Apt 3 Boston MA 02118-1996 |
| Practice Telephone | 6176368200 |
| Practice Fax Number | 6176367587 |
| Mailing Telephone | 7705198108 |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2016-01-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2624 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 004199 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE | 000867701 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891244018 | Courtney M Petersen | Assistant Behavior Analyst | 16902 Camden Ave, Omaha, NE 68116-8023 | 2016-09-28 |
| 1215121991 | Courtney J Petersen | Speech-Language Pathologist | 1025 N Country Club Dr, Mesa, AZ 85201-3307 | 2007-09-05 |
| Street Address |
750 WASHINGTON ST # 178 TUFTS MEDICAL CENTER |
| City | BOSTON |
| State | MA |
| Zip Code | 02111-1526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689271397 | Maximilian Richert | Counselor | 25 Kingston St, 4r, Boston, MA 02111 | 2020-10-06 |
| 1558978957 | Tien-hsin Chang | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street (tufts University School of Dental Me, Boston, MA 02111 | 2020-09-29 |
| 1548883465 | Elizabeth Carter Stapleton | Dentist | Tufts School of Dental Medicine: Dept of Orthodontics, 1 Kneeland Street, Boston, MA 02111 | 2020-05-27 |
| 1932729597 | Jacob Joseph Kosarchuk | Neurological Surgery | 800 Washington Street, Proger 7, Boston, MA 02111 | 2020-04-23 |
| 1164051868 | Daniele Abela | Surgery | 860 Washington Street, South Building, 4th Floor, Boston, MA 02111 | 2020-04-04 |
| 1184265258 | Jade Orthodontics | Dentist | 30 Kneeland St, Suite 301, Boston, MA 02111 | 2019-09-30 |
| 1932753639 | Loukia Kamille Danaf | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street, Tufts University School of Dental Me, Boston, MA 02111 | 2019-07-31 |
| 1033771944 | Faris Khalifa | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street, 5th Floor, Boston, MA 02111 | 2019-07-01 |
| 1609437276 | Blair Hanna Ray Farbstein | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street, 3rd Floor, Boston, MA 02111 | 2019-06-25 |
| 1821658709 | Jennifer Drummond | Internal Medicine | 800 Washington St. Gme Office, Boston, MA 02111 | 2019-06-13 |
| Find all providers in zip 02111 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205435393 | Allison Lee Nocon | Physician Assistant | 289 Beacon St Apt 8, Boston, MA 02116-1263 | 2020-10-20 |
| 1336746775 | Lee T Gernon-lakin | Physician Assistant | 202 Robinson Hall, 360 Huntington Ave, Boston, MA 02215 | 2020-10-08 |
| 1639781230 | Amanda Mae Saxton | Physician Assistant | 1410 Columbia Rd Apt 8g, Boston, MA 02127-4016 | 2020-08-17 |
| 1336757137 | Sabrina J Jamiel | Physician Assistant | 144 Calumet St Apt 3, Boston, MA 02120-3378 | 2020-07-17 |
| 1811505969 | Matthew George Cronin | Physician Assistant | 105 Landseer St, Boston, MA 02132-3436 | 2020-07-15 |
| 1902420284 | Rebecca Lee | Physician Assistant | 89 Chester St Apt A5, Boston, MA 02134-2219 | 2020-06-03 |
| 1982239430 | Catherine Dam | Physician Assistant | 357 Commercial St Apt 420, Boston, MA 02109-1236 | 2020-03-05 |
| 1033742390 | Melissa Stathas | Physician Assistant | 32 Fruit St Bldg 5th, Boston, MA 02114-2620 | 2020-02-14 |
| 1831740448 | Jennifer Hughes | Physician Assistant | 55 Fruit Street, Founders 110, Boston, MA 02114 | 2019-09-25 |
| 1275184905 | Danielle Dacunha | Physician Assistant | 42 Worcester Sq Apt 10, Boston, MA 02118-2920 | 2019-09-24 |
| Find all providers in BOSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.