Healthcare Provider Details

I. General information

NPI: 1619084324
Provider Name (Legal Business Name): MARYANN ELLIS FOSTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANN ELLIS MD

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 SE MILL PLAIN BLVD
VANCOUVER WA
98684-6055
US

IV. Provider business mailing address

17101 NE STONEY MEADOWS DR
VANCOUVER WA
98682-5607
US

V. Phone/Fax

Practice location:
  • Phone: 360-418-6001
  • Fax:
Mailing address:
  • Phone: 360-944-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00031537
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD18609
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: