Provider Demographics
NPI:1609206069
Name:FOSTER, MYA
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:
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 1:9437 MUIRKIRK RD
Mailing Address - Street 2:APT 302
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2757
Mailing Address - Country:US
Mailing Address - Phone:240-431-7445
Mailing Address - Fax:
Practice Address - Street 1:9437 MUIRKIRK RD
Practice Address - Street 2:APT 302
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2757
Practice Address - Country:US
Practice Address - Phone:240-431-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA6712374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide