Provider Demographics
NPI:1891406492
Name:FOSTER, MARY ANNETTE (PRSS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNETTE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3013
Mailing Address - Country:US
Mailing Address - Phone:304-710-5991
Mailing Address - Fax:
Practice Address - Street 1:607 10TH AVE W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3013
Practice Address - Country:US
Practice Address - Phone:304-710-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist