Provider Demographics
NPI:1558034157
Name:PUTNAM, COURTNEY ALYSSA (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALYSSA
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ALYSSA
Other - Last Name:FLOTTERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 CANAL VIEW BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2815
Mailing Address - Country:US
Mailing Address - Phone:585-338-2700
Mailing Address - Fax:
Practice Address - Street 1:140 CANAL VIEW BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2815
Practice Address - Country:US
Practice Address - Phone:585-338-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26720363AM0700X
NY026720363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical