Provider Demographics
NPI:1497485882
Name:PELOQUIN, COURTNEY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PELOQUIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9311 STATION CIR
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4597
Mailing Address - Country:US
Mailing Address - Phone:617-949-6303
Mailing Address - Fax:
Practice Address - Street 1:99 LORING DR
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8785
Practice Address - Country:US
Practice Address - Phone:617-949-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216324363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health