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General NPI Number Information
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NPI Number | 1255723508
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Entity Type | Individual
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Provider Name | STEPHANIE FOSTER PA-C, RD, LD
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Gender | Female
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 02/06/2022
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Provider Practice Location Address
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Address Line | 18101 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44111-5612
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Country | US
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Telephone | 330-289-4619
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Fax |
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Provider Business Mailing Address
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Address Line | 2768 STUBBINS RD
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City | BRECKSVILLE
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State | OH
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Zip | 44141-4020
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Country | US
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Telephone | 330-289-4619
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.007114RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 7318
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License Number State | OH
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