Provider Demographics
NPI:1366499600
Name:FOSTER, MONICA M (LRD/CDE)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LRD/CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2874
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2874
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1366499600Medicaid
MN6300064OtherMEDICA #
MNHP38648OtherHEALTHPARTNERS #
MN6300065OtherMEDICA #
MN13182Medicaid
MN13807OtherNDBS #
MN6300068OtherMEDICA #
MN710000149Medicare ID - Type UnspecifiedMN MEDICARE #
MN1366499600Medicaid
MN710000611Medicare PIN