Provider Demographics
NPI:1659744738
Name:FOSTER, CHARLOTTE ANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-1906
Mailing Address - Country:US
Mailing Address - Phone:217-853-2846
Mailing Address - Fax:
Practice Address - Street 1:9483 ROUTE 20 W
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-9182
Practice Address - Country:US
Practice Address - Phone:815-777-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041403979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse