Healthcare Provider Details

I. General information

NPI: 1841755691
Provider Name (Legal Business Name): JOLIE ANN FOSTER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 SUNSET LN NE UNIT 106
RENTON WA
98056-3145
US

IV. Provider business mailing address

2715 SUNSET LN NE UNIT 106
RENTON WA
98056-3145
US

V. Phone/Fax

Practice location:
  • Phone: 425-873-6184
  • Fax:
Mailing address:
  • Phone: 425-873-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number61491674
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61501664
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: