Healthcare Provider Details

I. General information

NPI: 1447070743
Provider Name (Legal Business Name): TERESE FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MERIDIAN ST
NEWBERG OR
97132-2697
US

IV. Provider business mailing address

18040 SW LOWER BOONES FERRY RD STE 204
TIGARD OR
97224-7259
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-2521
  • Fax:
Mailing address:
  • Phone: 503-962-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA228769
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: