Provider Demographics
NPI:1467420349
Name:FOSTER, MARY LYNN ZAZZI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY LYNN
Middle Name:ZAZZI
Last Name:FOSTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:Z
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:314 HOLSTON TER
Mailing Address - Street 2:
Mailing Address - City:WEBER CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24290-6905
Mailing Address - Country:US
Mailing Address - Phone:276-386-1312
Mailing Address - Fax:276-386-2116
Practice Address - Street 1:112 BEECH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3638
Practice Address - Country:US
Practice Address - Phone:276-386-1312
Practice Address - Fax:276-386-2116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS96372Medicare UPIN