Provider Demographics
NPI:1790958908
Name:FOSS, BETH ELLEN (LPN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:FOSS
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 1:442 MILL POND DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-1400
Mailing Address - Country:US
Mailing Address - Phone:419-602-3805
Mailing Address - Fax:419-517-3487
Practice Address - Street 1:442 MILL POND DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-1400
Practice Address - Country:US
Practice Address - Phone:419-602-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121606164W00000X
OHPN 121606 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse