Healthcare Provider Details

I. General information

NPI: 1942908488
Provider Name (Legal Business Name): FOSTER WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BLACKLICK EASTERN RD STE 130
PICKERINGTON OH
43147-7702
US

IV. Provider business mailing address

10400 BLACKLICK EASTERN RD STE 110
PICKERINGTON OH
43147-7702
US

V. Phone/Fax

Practice location:
  • Phone: 305-367-8378
  • Fax: 614-639-8001
Mailing address:
  • Phone: 305-367-8378
  • Fax: 614-639-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE MARKO
Title or Position: CEO/NURSE PRACTITIONER
Credential: APRN
Phone: 614-578-8768