Provider Demographics
NPI:1619110749
Name:FOSTER, THERESA LYN (LPN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LYN
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 1:13065 KING RD
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-8126
Mailing Address - Country:US
Mailing Address - Phone:740-467-2670
Mailing Address - Fax:
Practice Address - Street 1:13065 KING RD
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-8126
Practice Address - Country:US
Practice Address - Phone:740-467-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN104240164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2689630Medicaid