Healthcare Provider Details

I. General information

NPI: 1487328506
Provider Name (Legal Business Name): ANNE O'BRIEN FOSTER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE O'BRIEN

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 8TH ST STE 3B
SPRINGFIELD IL
62701-1041
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-7123
  • Fax: 217-545-7305
Mailing address:
  • Phone: 217-545-8000
  • Fax: 844-470-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.023693
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023693
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: