Healthcare Provider Details

I. General information

NPI: 1053625798
Provider Name (Legal Business Name): JULIE ANN FOURNIER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BURGESS ST
DELTA CO
81416-2849
US

IV. Provider business mailing address

PO BOX 10100
DELTA CO
81416-0008
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-7668
  • Fax: 970-874-0708
Mailing address:
  • Phone: 970-874-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number990777
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: