Provider Demographics
NPI:1073993978
Name:FOSTER, AUDREY (RDN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 E COLUMBIA AVE
Mailing Address - Street 2:APT 2F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2627
Mailing Address - Country:US
Mailing Address - Phone:267-530-4481
Mailing Address - Fax:
Practice Address - Street 1:1419 E COLUMBIA AVE
Practice Address - Street 2:APT 2F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-2627
Practice Address - Country:US
Practice Address - Phone:267-530-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86022655133V00000X
PADN005596133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered