Provider Demographics
NPI:1598192304
Name:FOSTER, BROOKE A (LPN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 FAIRWAY CIR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-1903
Mailing Address - Country:US
Mailing Address - Phone:419-541-1618
Mailing Address - Fax:
Practice Address - Street 1:120 FAIRWAY CIR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1903
Practice Address - Country:US
Practice Address - Phone:419-541-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN- 154407164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse