Provider Demographics
NPI:1811629660
Name:FOSTER, DARNELL
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21939 N 260TH LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-5450
Mailing Address - Country:US
Mailing Address - Phone:602-475-2092
Mailing Address - Fax:
Practice Address - Street 1:23646 W LEVI DR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-7362
Practice Address - Country:US
Practice Address - Phone:602-475-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8939667Medicaid