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General NPI Number Information
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NPI Number | 1558728204
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Entity Type | Individual
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Provider Name | JORDAN FOSTER NP
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Gender | Female
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 530 LYTTON AVE FL 2
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City | PALO ALTO
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State | CA
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Zip | 94301-1541
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Country | US
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Telephone | 631-793-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 1 EISENHOWER DR
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City | EAST QUOGUE
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State | NY
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Zip | 11942-4726
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Country | US
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Telephone | 631-793-0041
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 340266
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License Number State | NY
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