Provider Demographics
NPI:1770565475
Name:LACOURSIERE ZUCCHERO, TERRI L (PHD, RN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:L
Last Name:LACOURSIERE ZUCCHERO
Suffix:
Gender:F
Credentials:PHD, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2524
Mailing Address - Country:US
Mailing Address - Phone:857-654-1000
Mailing Address - Fax:857-654-1100
Practice Address - Street 1:780 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2524
Practice Address - Country:US
Practice Address - Phone:857-654-1000
Practice Address - Fax:857-654-1100
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000252460OtherHMSA
HIPENDINGMedicaid
HI990159253OtherHMAA
HI9976271OtherUNIVERSITY HEALTH ALLIANC
HI0000252460OtherHMSA
HIPENDINGMedicare ID - Type Unspecified