Provider Demographics
NPI:1376760405
Name:FOSTER, RAYLENE M (MS,RD,CDE)
Entity Type:Individual
Prefix:
First Name:RAYLENE
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS,RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 RIVER EDGE VIEW CT NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7220
Mailing Address - Country:US
Mailing Address - Phone:616-340-1911
Mailing Address - Fax:616-883-6074
Practice Address - Street 1:3585 RIVER EDGE VIEW CT NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7220
Practice Address - Country:US
Practice Address - Phone:616-340-1911
Practice Address - Fax:616-883-6074
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI862821133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered