Provider Demographics
NPI:1083893168
Name:FOUST, MICHELLE ANNE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:FOUST
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 1:550 SANDHURST DR W APT 122
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4679
Mailing Address - Country:US
Mailing Address - Phone:612-872-8811
Mailing Address - Fax:612-872-8866
Practice Address - Street 1:1421 PARK AVE
Practice Address - Street 2:SUITE # 104
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-5200
Practice Address - Country:US
Practice Address - Phone:612-872-8811
Practice Address - Fax:812-872-8866
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-132960-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse