Provider Demographics
NPI:1669720306
Name:FOURNIER, JOAHNNA L (CRNP, CPNP-PC)
Entity type:Individual
Prefix:
First Name:JOAHNNA
Middle Name:L
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:CRNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SISTER PIERRE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7526
Mailing Address - Country:US
Mailing Address - Phone:410-769-8801
Mailing Address - Fax:
Practice Address - Street 1:1814 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2734
Practice Address - Country:US
Practice Address - Phone:443-981-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174382363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics