Provider Demographics
NPI:1780314617
Name:FOSTER, ANGELA MICHELLE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6407
Mailing Address - Country:US
Mailing Address - Phone:336-344-2054
Mailing Address - Fax:336-234-1442
Practice Address - Street 1:4124 DONEGAL DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-6407
Practice Address - Country:US
Practice Address - Phone:336-344-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000005491506172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver