Individual
LAECEY MAE FOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
671 SW MAIN ST, WINSTON, OR 97496-6571
(541) 492-4550
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA221667
OR
Other
Enumeration date
07/09/2024
Last updated
05/27/2025
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