Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 0104001244 | VA |
NPI | 1053474502 |
---|---|
Provider Name | Dr. Andra Schmidt Foster |
First Address | Virginia Beach, VA 23464-2406 |
Second Address | Virginia Beach, VA 23452-1150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 04/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053474502 | NPI (PRACTICE) (01) | VA |
179704 | ANTHEM PROVIDER NUMBER (01) | VA |
U41788 | (02) | VA |
VA0104001244 | VIRGINIA LICENSE NUMBER (01) | VA |