Provider Demographics
NPI:1629381579
Name:FOURNIER, MARYANNE F (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:F
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SANDOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03873-2510
Mailing Address - Country:US
Mailing Address - Phone:978-505-1296
Mailing Address - Fax:978-824-2442
Practice Address - Street 1:445 CYPRESS ST STE 8
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3600
Practice Address - Country:US
Practice Address - Phone:603-668-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH038180-23363LP0808X
MARN202614163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1154302586Medicaid