Individual
JONATHAN FOSTER-MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
45 DIMOCK ST, ROXBURY, MA 02119-1208
(617) 442-8800
(617) 541-8472
Mailing address
112 HYDE PARK AVE APT 3, BOSTON, MA 02130-4155
(413) 588-1685
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2330326
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110164952A
—
MA
Enumeration date
07/23/2020
Last updated
11/16/2020
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