Provider Demographics
NPI:1619255908
Name:FOURNIER, EVA JANE
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:JANE
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 NW BELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-6315
Mailing Address - Country:US
Mailing Address - Phone:580-919-7674
Mailing Address - Fax:
Practice Address - Street 1:1810 NW BELL AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-6315
Practice Address - Country:US
Practice Address - Phone:580-919-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health