Basic Information
| Provider Information | |||||||||
| NPI: | 1740335173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | GLADNEY | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1318 S 284TH ST # L | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538390885 | ||||||||
| FaxNumber: | 2534491822 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 COLLEGE ST SE | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985031014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604563200 | ||||||||
| FaxNumber: | 3604563894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP30001088 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.