Provider Demographics
NPI:1033653506
Name:FOSTER, KEYANNA
Entity Type:Individual
Prefix:
First Name:KEYANNA
Middle Name:
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 1:1235 GENEI CT W APT 204
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-6797
Mailing Address - Country:US
Mailing Address - Phone:989-714-5987
Mailing Address - Fax:
Practice Address - Street 1:1235 GENEI CT W APT 204
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-6797
Practice Address - Country:US
Practice Address - Phone:989-714-5987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other