Provider Demographics
NPI:1700596210
Name:FOSTER, EMILY MAY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3215
Mailing Address - Country:US
Mailing Address - Phone:607-592-7932
Mailing Address - Fax:
Practice Address - Street 1:720 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3215
Practice Address - Country:US
Practice Address - Phone:607-592-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311076-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000000000000Medicaid