Healthcare Provider Details

I. General information

NPI: 1801898275
Provider Name (Legal Business Name): JENNIFER FOURNIER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BEACH

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

147 MILK ST
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-1126
  • Fax: 617-421-1066
Mailing address:
  • Phone: 617-421-6540
  • Fax: 617-421-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number250635
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: