Provider Demographics
NPI:1548214885
Name:FOURMAN, ELIZABETH ANNE (MSN, NP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:FOURMAN
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HOLY CROSS HALL
Mailing Address - Street 2:SAINT MARY'S COLLEGE,
Mailing Address - City:NOTRE DAME
Mailing Address - State:IN
Mailing Address - Zip Code:46556-5001
Mailing Address - Country:US
Mailing Address - Phone:574-284-4805
Mailing Address - Fax:574-284-4833
Practice Address - Street 1:50 HOLY CROSS HALL
Practice Address - Street 2:SAINT MARY'S COLLEGE
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556-5001
Practice Address - Country:US
Practice Address - Phone:574-284-4805
Practice Address - Fax:574-284-4833
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000780A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200295980Medicaid
238760KMedicare ID - Type Unspecified
IN200295980Medicaid