Healthcare Provider Details

I. General information

NPI: 1871579664
Provider Name (Legal Business Name): NICOLE LEIGH FOSTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E SHAW AVE STE 105
FRESNO CA
93710-7838
US

IV. Provider business mailing address

1130 E SHAW AVE STE 105
FRESNO CA
93710-7838
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4000
  • Fax:
Mailing address:
  • Phone: 559-376-7921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: