Healthcare Provider Details

I. General information

NPI: 1649802182
Provider Name (Legal Business Name): KALEEN MARIE FOSTER LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CHATEAU DR
CRESTLINE CA
92325-9501
US

IV. Provider business mailing address

PO BOX 3342
CRESTLINE CA
92325-3342
US

V. Phone/Fax

Practice location:
  • Phone: 763-772-5896
  • Fax:
Mailing address:
  • Phone: 763-772-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: