Provider Demographics
NPI:1699817932
Name:VERDI-COURNOYER, ANNA (EDD, APRN-BC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VERDI-COURNOYER
Suffix:
Gender:F
Credentials:EDD, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-6461
Mailing Address - Country:US
Mailing Address - Phone:413-493-1997
Mailing Address - Fax:413-665-4695
Practice Address - Street 1:27 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-6461
Practice Address - Country:US
Practice Address - Phone:413-493-1997
Practice Address - Fax:413-665-4695
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157190364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1859927OtherMASSHEALTH MDCR CROSSOVER
MAQMB PROVIDERMedicaid
MA017754000OtherMAGELLAN BEHAVIORAL HEALT
MA4337962OtherAETNA
MAPN0153OtherBLUE CROSS BLUE SHIELD
MANS0062Medicare ID - Type UnspecifiedMEDICARE