1437843661 NPI number — LISA CENTOLA FOURNIER LPN

Table of content: LISA CENTOLA FOURNIER LPN (NPI 1437843661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437843661 NPI number — LISA CENTOLA FOURNIER LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOURNIER
Provider First Name:
LISA
Provider Middle Name:
CENTOLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CENTOLA
Provider Other First Name:
LISA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437843661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 BURLEY ST APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01984-1904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-615-3573
Provider Business Mailing Address Fax Number:
978-705-6375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 LINDALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVERS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01923-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-223-9594
Provider Business Practice Location Address Fax Number:
978-705-6375
Provider Enumeration Date:
06/08/2023

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: 164W00000X , with the licence number:  LN59241 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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