Provider Demographics
NPI:1376891275
Name:FOSTER, NANCY A (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12885 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8717
Mailing Address - Country:US
Mailing Address - Phone:616-935-9734
Mailing Address - Fax:616-414-5000
Practice Address - Street 1:12885 GREEN ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8717
Practice Address - Country:US
Practice Address - Phone:616-935-9734
Practice Address - Fax:616-414-5000
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117560163WC0400X
IN28138932A163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management