Provider Demographics
NPI:1093018590
Name:FOSTER, MONIQUE ANNE (ATC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ANNE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 PARKLAWN AVE
Mailing Address - Street 2:APT 308
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4684
Mailing Address - Country:US
Mailing Address - Phone:262-352-7215
Mailing Address - Fax:
Practice Address - Street 1:8100 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4800
Practice Address - Country:US
Practice Address - Phone:952-806-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer