Provider Demographics
NPI:1225380942
Name:COURCHENE, YELENA NICOLAEVNA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:NICOLAEVNA
Last Name:COURCHENE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOUND CT
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4412
Mailing Address - Country:US
Mailing Address - Phone:603-424-8866
Mailing Address - Fax:833-944-2252
Practice Address - Street 1:3 MOUND CT
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4412
Practice Address - Country:US
Practice Address - Phone:603-424-8866
Practice Address - Fax:833-944-2252
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0916363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3096835Medicaid