Provider Demographics
NPI:1639407513
Name:RISLEY, COURTNEY LOPER (CPNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LOPER
Last Name:RISLEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MARY
Other - Last Name:LOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:300 LONGWOOD AVENUE
Mailing Address - Street 2:FARLEY BUILDING ROOM 403
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-7636
Mailing Address - Fax:617-730-0034
Practice Address - Street 1:BOSTON CHILDREN'S HOSPITAL, 300 LONGWOOD AVENUE
Practice Address - Street 2:FARLEY BUILDING ROOM 403
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-7636
Practice Address - Fax:617-730-0034
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN269801363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics