Healthcare Provider Details

I. General information

NPI: 1033417779
Provider Name (Legal Business Name): LINDA ANN FOURNIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA ANN FOURNIER RN

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1000
  • Fax: 617-665-2891
Mailing address:
  • Phone: 617-665-1000
  • Fax: 617-665-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number127608
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: