Healthcare Provider Details

I. General information

NPI: 1083893168
Provider Name (Legal Business Name): MICHELLE ANNE FOUST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 PARK AVE SUITE # 104
MINNEAPOLIS MN
55404-5200
US

IV. Provider business mailing address

550 SANDHURST DR W APT 122
SAINT PAUL MN
55113-4679
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-8811
  • Fax: 812-872-8866
Mailing address:
  • Phone: 612-872-8811
  • Fax: 612-872-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR-132960-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: