MEDICARE: MR. DAVID T. FOSS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP-396A	ID

General Provider Information

NPI Number	:	1366412595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID T. FOSS FNP

Provider Business Mailing Address
First Line	:	11193 W HICKORY DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-2472
Country	:	US
Telephone Number	:	208-658-6139
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 16TH AVE N
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-4058
Country	:	US
Telephone Number	:	208-467-4431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	01/30/2012

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