Provider Demographics
NPI:1508574187
Name:FOURNIER, JOY (LAC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205A BOXWOOD RD APT 104
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1160
Mailing Address - Country:US
Mailing Address - Phone:862-220-2476
Mailing Address - Fax:
Practice Address - Street 1:2601 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1215
Practice Address - Country:US
Practice Address - Phone:862-220-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02373171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02373OtherMARYLAND BOARD OF ACUPUNCTURE