Provider Demographics
NPI:1750670121
Name:FOURNIER, LAWRENCE W JR (CRNA)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:W
Last Name:FOURNIER
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:13523 BARRETT PARKWAY DR
Mailing Address - Street 2:STE 210
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-3802
Mailing Address - Country:US
Mailing Address - Phone:314-775-2816
Mailing Address - Fax:314-775-2821
Practice Address - Street 1:1015 BOWLES AVE
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2394
Practice Address - Country:US
Practice Address - Phone:314-775-2816
Practice Address - Fax:314-775-2821
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2021-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2006023190367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered