Petersen, Courtney Slocum

Petersen, Courtney Slocum is an sole proprietor health care provider with primary practice located at 750 Washington St # 178 Tufts Medical Center, Boston MA 02111-1526. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Petersen, Courtney Slocum can be contacted via phone (617) 636-8200.

Contact Information

Primary practice address
750 Washington St # 178 Tufts Medical Center Boston MA 02111-1526
Phone: (617) 636-8200
Fax: (617) 636-7587
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 004199 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2624 Massachusetts

Profile Details

NPI number 1730184375
LBN Legal business name Petersen, Courtney Slocum
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 20th, 2005
Last updated Jan 14th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730184375 NPPES
Other 000867701 MEDICARE

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