Provider Demographics
NPI:1942908488
Name:FOSTER WELLNESS, LLC
Entity Type:Organization
Organization Name:FOSTER WELLNESS, LLC
Other - Org Name:FOSTER MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:614-578-8768
Mailing Address - Street 1:10400 BLACKLICK EASTERN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7702
Mailing Address - Country:US
Mailing Address - Phone:305-367-8378
Mailing Address - Fax:614-639-8001
Practice Address - Street 1:10400 BLACKLICK EASTERN RD STE 130
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7702
Practice Address - Country:US
Practice Address - Phone:305-367-8378
Practice Address - Fax:614-639-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH016320Medicaid
1346762465OtherNPI
OH0248012Medicaid