Provider Demographics
NPI:1457013393
Name:FOSTER, ANGELICA KATELINE
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:KATELINE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 WHITNEY RD STE 17
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3167
Mailing Address - Country:US
Mailing Address - Phone:864-345-0855
Mailing Address - Fax:
Practice Address - Street 1:359 WHITNEY RD STE 17
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3167
Practice Address - Country:US
Practice Address - Phone:864-345-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45451164W00000X
SCP45451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP45451OtherLPN NUMBER