Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 005022 | MO |
NPI | 1639175151 |
---|---|
Provider Name | Dr. Angela Foster |
First Address | Osage Beach, MO 65065-0328 |
Second Address | Osage Beach, MO 65065-2392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 08/07/2007 |