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General NPI Number Information
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NPI Number | 1386984425
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Entity Type | Individual
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Provider Name | GARY BRUCE FOSTER JR. REGISTERED NURSE
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Gender | Male
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 41250 BUTTERNUT RIDGE RD
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City | ELYRIA
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State | OH
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Zip | 44035-7431
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Country | US
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Telephone | 440-458-4183
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 FIRESTONE RD
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City | SPENCER
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State | OH
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Zip | 44275-9540
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Country | US
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Telephone | 330-635-9244
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 339799
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License Number State | OH
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