Provider Demographics
NPI:1750724753
Name:FOURNIER, TRACY ANN
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANN
Last Name:FOURNIER
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 1:1020 DUTCH FORK RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8822
Mailing Address - Country:US
Mailing Address - Phone:803-743-6533
Mailing Address - Fax:
Practice Address - Street 1:1020 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8822
Practice Address - Country:US
Practice Address - Phone:803-743-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC108485163WS0200X
SCRN 108485163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool