Provider Demographics
NPI:1417069709
Name:FOSTER, DIANE BRILEY (PA)
Entity Type:Individual
Prefix:MR
First Name:DIANE
Middle Name:BRILEY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-969-1167
Mailing Address - Fax:630-969-1297
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-969-1167
Practice Address - Fax:630-969-1297
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMF0706222OtherDEA NUMBER