Provider Demographics
NPI:1689860694
Name:KOURTZ, MCLAIN NOBEL (PA-C)
Entity Type:Individual
Prefix:
First Name:MCLAIN
Middle Name:NOBEL
Last Name:KOURTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:MCLAIN NOBEL
Other - Last Name:KOURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:SUITE 56
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-7000
Mailing Address - Fax:
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 56
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP2391363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical