Provider Demographics
NPI:1407805005
Name:FOSTER, RITA (NURSE LPN)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NURSE LPN
Other - Prefix:MS
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:WEICHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4653 S WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3845
Mailing Address - Country:US
Mailing Address - Phone:414-281-1851
Mailing Address - Fax:
Practice Address - Street 1:122 EAGLE LAKE AVE
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149
Practice Address - Country:US
Practice Address - Phone:262-363-5554
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12555031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39828100Medicaid