Provider Demographics
NPI:1013376466
Name:FOSTER, ANGELA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:DEFALCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2516 BOND AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1602
Mailing Address - Country:US
Mailing Address - Phone:610-291-9334
Mailing Address - Fax:
Practice Address - Street 1:1776 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1550
Practice Address - Country:US
Practice Address - Phone:610-647-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-14
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily