Healthcare Provider Details

I. General information

NPI: 1205450202
Provider Name (Legal Business Name): JEFF FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax: 303-602-5184
Mailing address:
  • Phone: 303-436-4949
  • Fax: 303-602-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1621533
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0995551-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: