Basic Information
| Provider Information | |||||||||
| NPI: | 1609387083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | LESLIE | ||||||||
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| Credential: | MSN, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2607 S SOUTHEAST BLVD BLDG A | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992234942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094646208 | ||||||||
| FaxNumber: | 8883161928 | ||||||||
| Practice Location | |||||||||
| Address1: | 2607 S SOUTHEAST BLVD | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094646208 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2017 | ||||||||
| LastUpdateDate: | 05/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4707263457 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | 4707263457 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 2081P2900X | AP607873 | WA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2121161 | 05 | WA | MEDICAID |