Healthcare Provider Details

I. General information

NPI: 1508574187
Provider Name (Legal Business Name): JOY FOURNIER L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 MOUNTAIN RD
PASADENA MD
21122-1215
US

IV. Provider business mailing address

205A BOXWOOD RD APT 104
ANNAPOLIS MD
21403-1160
US

V. Phone/Fax

Practice location:
  • Phone: 862-220-2476
  • Fax:
Mailing address:
  • Phone: 862-220-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02373
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: