Provider Demographics
NPI:1972849297
Name:FOURNIER, EMILY JOHANSSON (CPNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOHANSSON
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1916
Mailing Address - Country:US
Mailing Address - Phone:860-716-5962
Mailing Address - Fax:
Practice Address - Street 1:9094 E MINERAL CIR STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-7201
Practice Address - Country:US
Practice Address - Phone:303-694-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992790-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care