Healthcare Provider Details

I. General information

NPI: 1669905584
Provider Name (Legal Business Name): JODIE FOSTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 CHERRY ST
TOLEDO OH
43608-2906
US

IV. Provider business mailing address

1212 CHERRY ST
TOLEDO OH
43608-2906
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-0631
  • Fax: 419-936-7606
Mailing address:
  • Phone: 419-693-0631
  • Fax: 419-936-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.317008
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: