Provider Demographics
NPI:1649802182
Name:FOSTER, KALEEN MARIE (LM, CPM)
Entity type:Individual
Prefix:
First Name:KALEEN
Middle Name:MARIE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3342
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-3342
Mailing Address - Country:US
Mailing Address - Phone:763-772-5896
Mailing Address - Fax:
Practice Address - Street 1:800 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325-9501
Practice Address - Country:US
Practice Address - Phone:763-772-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM598176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty