Healthcare Provider Details

I. General information

NPI: 1447482427
Provider Name (Legal Business Name): MARK E COURTNEY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FRANCIS ST SUITE 2A
BOSTON MA
02215-5501
US

IV. Provider business mailing address

110 FRANCIS ST SUITE 2A
BOSTON MA
02215-5501
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-2823
  • Fax:
Mailing address:
  • Phone: 617-754-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number152350
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: