Provider Demographics
NPI:1669777090
Name:FOSTER, LISA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 AERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3320
Mailing Address - Country:US
Mailing Address - Phone:937-648-3943
Mailing Address - Fax:937-648-3943
Practice Address - Street 1:3718 AERIAL AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3320
Practice Address - Country:US
Practice Address - Phone:937-648-3943
Practice Address - Fax:937-648-3943
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN125611MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse