Healthcare Provider Details

I. General information

NPI: 1083256002
Provider Name (Legal Business Name): LAUREN A FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W JAMES ST
PAYNESVILLE MN
56362-1216
US

IV. Provider business mailing address

201 VICTORY AVE
SARTELL MN
56377-4620
US

V. Phone/Fax

Practice location:
  • Phone: 320-243-3379
  • Fax: 320-243-3138
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: