1114091881 NPI number — MRS. STEPHANIE FAYE FOURNIER R.PH.

Table of content: MRS. STEPHANIE FAYE FOURNIER R.PH. (NPI 1114091881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114091881 NPI number — MRS. STEPHANIE FAYE FOURNIER R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOURNIER
Provider First Name:
STEPHANIE
Provider Middle Name:
FAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEMLER
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
FAYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.PH.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1114091881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1283 NORTHRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STORY CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50248-9505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STORY CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50248-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-733-2252
Provider Business Practice Location Address Fax Number:
515-733-4569
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  17732 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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