Provider Demographics
NPI:1104171545
Name:SMITH, COURTNEY WASSON (NP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:WASSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:A
Other - Last Name:WASSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:223 CHIEF JUSTICE CUSHING HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1391
Mailing Address - Country:US
Mailing Address - Phone:781-383-6261
Mailing Address - Fax:781-812-1631
Practice Address - Street 1:223 CHIEF JUSTICE CUSHING HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1391
Practice Address - Country:US
Practice Address - Phone:781-383-6261
Practice Address - Fax:781-812-1631
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily