Provider Demographics
NPI:1740335173
Name:FOSTER, CHARLENE GLADNEY (CRNA)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:GLADNEY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1318 S 284TH ST # L
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6111
Mailing Address - Country:US
Mailing Address - Phone:253-839-0885
Mailing Address - Fax:253-449-1822
Practice Address - Street 1:345 COLLEGE ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1014
Practice Address - Country:US
Practice Address - Phone:360-456-3200
Practice Address - Fax:360-456-3894
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30001088367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered