Provider Demographics
NPI:1881637015
Name:FOSTER, JENNIFER A (PROSTHETIST CP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PROSTHETIST CP
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Mailing Address - Street 1:1111 LEFFINGWELL AVE NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6406
Mailing Address - Country:US
Mailing Address - Phone:616-459-7101
Mailing Address - Fax:616-942-2146
Practice Address - Street 1:230 MICHIGAN ST NE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-459-7101
Practice Address - Fax:616-942-2146
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MICP003398224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0D14869Medicare ID - Type Unspecified