Healthcare Provider Details

I. General information

NPI: 1891730628
Provider Name (Legal Business Name): SUSAN DIANE FOSTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 LOW CT
FAIRFIELD CA
94534-9771
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 707-427-4900
  • Fax: 707-428-2715
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP10757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: