Provider Demographics
NPI:1659941094
Name:FOSTER, LORNA MARIE
Entity Type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:MARIE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LORNA
Other - Middle Name:MARIE
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DAWSON
Mailing Address - Street 1:1528 COUNTY ROAD 550 E
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-7821
Mailing Address - Country:US
Mailing Address - Phone:309-370-5568
Mailing Address - Fax:
Practice Address - Street 1:8914 N PRAIRIE POINTE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1574
Practice Address - Country:US
Practice Address - Phone:877-726-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.429733163W00000X
IL041429733163WM0705X
IL209.023157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical