Provider Demographics
NPI:1154436541
Name:NASCIMENTO, COURTNEY M (MS, MPH, NP-C, RN,RD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:NASCIMENTO
Suffix:
Gender:F
Credentials:MS, MPH, NP-C, RN,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-655-0525
Mailing Address - Fax:
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-655-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2030133N00000X
MARN2262989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7776618OtherAETNA/US HEALTHCARE
AA16846OtherHARVARD PILGRIM HEALTHCAR
67595OtherFALLON CUMMUNITY HEALTH P
LD0138OtherBLUE CROSS
MT0710OtherMEDICARE B
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTREE RIVERS
042472266OtherTREE RIVERS