Provider Demographics
NPI:1841533452
Name:FOSTER, BONNIE LILA (WHNP)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LILA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6261
Mailing Address - Country:US
Mailing Address - Phone:817-776-0903
Mailing Address - Fax:
Practice Address - Street 1:1508 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6261
Practice Address - Country:US
Practice Address - Phone:817-776-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX539997363LW0102X
TXAP122226363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health