Healthcare Provider Details

I. General information

NPI: 1780194787
Provider Name (Legal Business Name): CHARLOTTE JOHNSON FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 NORVIEW AVE APT E1
NORFOLK VA
23518-5539
US

IV. Provider business mailing address

PO BOX 2672
NORFOLK VA
23501-2672
US

V. Phone/Fax

Practice location:
  • Phone: 757-580-2203
  • Fax: 757-623-0101
Mailing address:
  • Phone: 757-580-2203
  • Fax: 757-623-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number22772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: