Individual
JERRY L FOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1270 KOTNUM ROAD, WARM SPRING, OR 97761-1209
(541) 553-1196
Mailing address
PO BOX 1209, WARM SPRING, OR 97761-1209
(541) 553-1196
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R41699
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273855
—
OR
Enumeration date
07/02/2008
Last updated
06/08/2015
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