Provider Demographics
NPI:1891301594
Name:FOSTER, ANESSA EVE
Entity Type:Individual
Prefix:
First Name:ANESSA
Middle Name:EVE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 W STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3762
Mailing Address - Country:US
Mailing Address - Phone:541-621-2294
Mailing Address - Fax:541-621-2294
Practice Address - Street 1:103 ROSE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2556
Practice Address - Country:US
Practice Address - Phone:541-301-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide