Provider Demographics
NPI:1811390495
Name:FORTIER, LUANNE
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:
Last Name:FORTIER
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 1:2620 S PARKER RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1608
Mailing Address - Country:US
Mailing Address - Phone:303-695-9392
Mailing Address - Fax:303-671-0097
Practice Address - Street 1:2620 S PARKER RD
Practice Address - Street 2:SUITE 140
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1608
Practice Address - Country:US
Practice Address - Phone:303-695-9392
Practice Address - Fax:303-671-0097
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor