Provider Demographics
NPI:1053628008
Name:FOSTER, JILL M (LPN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PARK DR
Mailing Address - Street 2:APT 103
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-6042
Mailing Address - Country:US
Mailing Address - Phone:845-656-4128
Mailing Address - Fax:
Practice Address - Street 1:27 PARK DRIVE
Practice Address - Street 2:APT 103
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-5304
Practice Address - Country:US
Practice Address - Phone:845-656-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10273665164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse