Provider Demographics
NPI:1003274846
Name:FOSTER, SHANNON GAYLE
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:GAYLE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 W ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:PENTWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49449-8579
Mailing Address - Country:US
Mailing Address - Phone:231-923-6167
Mailing Address - Fax:
Practice Address - Street 1:2960 W ADAMS RD
Practice Address - Street 2:
Practice Address - City:PENTWATER
Practice Address - State:MI
Practice Address - Zip Code:49449-8579
Practice Address - Country:US
Practice Address - Phone:231-923-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other