Provider Demographics
NPI:1841755691
Name:FOSTER, JOLIE ANN (LAC)
Entity Type:Individual
Prefix:MISS
First Name:JOLIE
Middle Name:ANN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S DAHLIA CIR APT A-207
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1386
Mailing Address - Country:US
Mailing Address - Phone:763-443-6699
Mailing Address - Fax:
Practice Address - Street 1:10375 PARK MEADOWS DR # 270
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6735
Practice Address - Country:US
Practice Address - Phone:303-351-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002467171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist