Healthcare Provider Details

I. General information

NPI: 1891615027
Provider Name (Legal Business Name): NERISSA FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 KNOLLWOOD APTS DR
LANCASTER SC
29720-6763
US

IV. Provider business mailing address

254 KNOLLWOOD DRIVE APT A APT. A
LANCASTER SC
29720
US

V. Phone/Fax

Practice location:
  • Phone: 704-408-1707
  • Fax:
Mailing address:
  • Phone: 704-408-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number163WH0200X
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: