Provider Demographics
NPI:1073897724
Name:FOSTER, MARY LOU (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY LOU
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355111 E 1020 RD
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-1103
Mailing Address - Country:US
Mailing Address - Phone:405-567-3025
Mailing Address - Fax:
Practice Address - Street 1:355111 E 1020 RD
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-1103
Practice Address - Country:US
Practice Address - Phone:405-567-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse