Individual
TRACIE FOSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1441 W BROADWAY, CENTRALIA, IL 62801-5613
(618) 532-9050
Mailing address
PO BOX 955860, SAINT LOUIS, MO 63195-3060
(636) 498-5944
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209072853
IL
Other
Enumeration date
03/02/2015
Last updated
10/19/2020
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