Provider Demographics
NPI:1346903150
Name:FOSS, NICOLE ANN (LPN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:FOSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5197 NW LOWER RIVER RD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660
Mailing Address - Country:US
Mailing Address - Phone:360-205-1222
Mailing Address - Fax:360-469-1720
Practice Address - Street 1:5197 NW LOWER RIVER RD
Practice Address - Street 2:BUILDING 1
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660
Practice Address - Country:US
Practice Address - Phone:360-205-1222
Practice Address - Fax:360-469-1720
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61188184164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse