Healthcare Provider Details

I. General information

NPI: 1811963382
Provider Name (Legal Business Name): AMY L FOSTER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 BROADWAY ST NE STE 300
MINNEAPOLIS MN
55413-1761
US

IV. Provider business mailing address

3433 BROADWAY ST NE STE 300
MINNEAPOLIS MN
55413-1761
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-7737
  • Fax: 763-587-7069
Mailing address:
  • Phone: 763-587-7737
  • Fax: 763-587-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1415076
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR141507-6
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0954
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: