Provider Demographics
NPI:1861641540
Name:FOSTER, JENILEE ROSE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENILEE
Middle Name:ROSE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2204 WILBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592
Mailing Address - Country:US
Mailing Address - Phone:434-517-3136
Mailing Address - Fax:434-517-3626
Practice Address - Street 1:2204 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1645
Practice Address - Country:US
Practice Address - Phone:434-517-3136
Practice Address - Fax:434-517-3626
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA00110002882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant