Provider Demographics
NPI:1508528423
Name:FOURNIER, KATHERINE ANTOINETTE (RN, BSN, CPHON, BMTC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANTOINETTE
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:RN, BSN, CPHON, BMTC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANTOINETTE
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 HUNTER LN
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2400
Practice Address - Country:US
Practice Address - Phone:978-501-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse