Provider Demographics
NPI:1689191009
Name:FOSTER, TARA KELLEEN (LPN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:KELLEEN
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 1:531 S 41ST PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7564
Mailing Address - Country:US
Mailing Address - Phone:541-915-8043
Mailing Address - Fax:
Practice Address - Street 1:531 S 41ST PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-7564
Practice Address - Country:US
Practice Address - Phone:541-915-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201407847LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse