MEDICARE: JENNIFER BROOKE FOSTER-NUR BCBA

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	103K00000X	Behavior Analyst	1-12-11905	CA

General Provider Information

NPI Number	:	1720343213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BROOKE FOSTER-NUR BCBA

Provider Business Mailing Address
First Line	:	PO BOX 2313
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93448-2313
Country	:	US
Telephone Number	:	559-871-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 DEER CANYON RD
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-4980
Country	:	US
Telephone Number	:	559-871-4749
Fax Number	:

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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