Provider Demographics
NPI:1609387083
Name:FOSTER, JAMES LESLIE (MSN, NP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LESLIE
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 S SOUTHEAST BLVD BLDG A
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4942
Mailing Address - Country:US
Mailing Address - Phone:509-464-6208
Mailing Address - Fax:888-316-1928
Practice Address - Street 1:2607 S SOUTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223
Practice Address - Country:US
Practice Address - Phone:509-464-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4707263457363L00000X, 363LA2200X
WAAP6078732081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2121161Medicaid
MI1598853608Medicaid