Provider Demographics
NPI:1083045397
Name:FOURNIER, NANCY ANN (ATC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6042
Mailing Address - Country:US
Mailing Address - Phone:207-786-8258
Mailing Address - Fax:207-755-5959
Practice Address - Street 1:130 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6042
Practice Address - Country:US
Practice Address - Phone:207-786-8258
Practice Address - Fax:207-755-5959
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT1622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer