Healthcare Provider Details

I. General information

NPI: 1649572645
Provider Name (Legal Business Name): SANDRA L FOURNIER RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 11/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 FABIEN ST
WOONSOCKET RI
02895-6277
US

IV. Provider business mailing address

80 FABIEN ST
WOONSOCKET RI
02895-6277
US

V. Phone/Fax

Practice location:
  • Phone: 401-765-3700
  • Fax: 401-769-0646
Mailing address:
  • Phone: 401-765-3700
  • Fax: 401-769-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN223566
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN34293
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: