Provider Demographics
NPI:1881135473
Name:FOSTER, NADEENA
Entity type:Individual
Prefix:
First Name:NADEENA
Middle Name:
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 1:3402 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1319
Mailing Address - Country:US
Mailing Address - Phone:402-312-1678
Mailing Address - Fax:
Practice Address - Street 1:3000 FARNAM ST STE 6
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3521
Practice Address - Country:US
Practice Address - Phone:402-451-5549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE39201810826101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39201810826Medicaid