Provider Demographics
NPI:1407362098
Name:FOSTER, MARILYN KAY (PCA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:KAY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:MARYILYN
Other - Middle Name:KAY
Other - Last Name:BEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 FLINTTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:GHANDEEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25243
Mailing Address - Country:US
Mailing Address - Phone:304-356-4562
Mailing Address - Fax:304-558-4563
Practice Address - Street 1:85 FLINTTOWN ROAD
Practice Address - Street 2:
Practice Address - City:GANDEEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25243
Practice Address - Country:US
Practice Address - Phone:304-927-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016051OtherPROVIDER ID