Provider Demographics
NPI:1437843661
Name:FOURNIER, LISA CENTOLA (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CENTOLA
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CENTOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:17 BURLEY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-1904
Mailing Address - Country:US
Mailing Address - Phone:857-615-3573
Mailing Address - Fax:978-705-6375
Practice Address - Street 1:75 LINDALL ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2121
Practice Address - Country:US
Practice Address - Phone:978-223-9594
Practice Address - Fax:978-705-6375
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN59241164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse