MEDICARE: RENICA FOSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	11972	LA

General Provider Information

NPI Number	:	1629440185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENICA FOSTER

Provider Business Mailing Address
First Line	:	1417 W MORRIS AVE STE E
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-3854
Country	:	US
Telephone Number	:	985-542-9949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 W MORRIS AVE STE E
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-3854
Country	:	US
Telephone Number	:	859-542-9949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2015
Last Update Date	:	05/08/2019

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Directions to “ RENICA FOSTER ” Practice Location

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