Provider Demographics
NPI:1164496444
Name:FOSTER, DAVID BURLEIGH (RN, FNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BURLEIGH
Last Name:FOSTER
Suffix:
Gender:M
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9202 N 47TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3603
Mailing Address - Country:US
Mailing Address - Phone:623-980-6764
Mailing Address - Fax:757-299-0453
Practice Address - Street 1:1209 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2605
Practice Address - Country:US
Practice Address - Phone:602-258-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ370363L00000X
AZRN084673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner