Healthcare Provider Details

I. General information

NPI: 1841988714
Provider Name (Legal Business Name): VICTORIA FOSTER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S 25TH ST
FORT DODGE IA
50501
US

IV. Provider business mailing address

530 SOUTH 25TH STREET
FORT DODGE IA
50501
US

V. Phone/Fax

Practice location:
  • Phone: 515-576-2235
  • Fax:
Mailing address:
  • Phone: 515-576-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP42002
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: