Provider Demographics
NPI:1477125730
Name:FOSTER, EVANJALEES (BS)
Entity type:Individual
Prefix:
First Name:EVANJALEES
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PARK VIEW LN STE 204
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5406
Mailing Address - Country:US
Mailing Address - Phone:304-243-1865
Mailing Address - Fax:
Practice Address - Street 1:111 PARK VIEW LN STE 204
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5406
Practice Address - Country:US
Practice Address - Phone:304-243-1865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator