MEDICARE: BRENDA FOSTER M.S., CHES

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	225400000X	Rehabilitation Practitioner
2	174H00000X	Health Educator

General Provider Information

NPI Number	:	1871962688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA FOSTER M.S., CHES

Provider Business Mailing Address
First Line	:	2410 FIRE MESA ST
Second Line	:	180
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9720 RED HORSE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1158
Country	:	US
Telephone Number	:	702-302-7272
Fax Number	:

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

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	03/17/2018

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