Provider Demographics
NPI:1740564152
Name:FOURNIER, ALETHEA JEANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:ALETHEA
Middle Name:JEANNE
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438A SAUSALITO BLVD
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2328
Mailing Address - Country:US
Mailing Address - Phone:206-225-7273
Mailing Address - Fax:
Practice Address - Street 1:438A SAUSALITO BLVD
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2328
Practice Address - Country:US
Practice Address - Phone:206-225-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21371363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health