Provider Demographics
NPI:1366791238
Name:FOSTER, WHITNEY R (NP-C)
Entity type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:R
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:RENEE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2121 LAKE AVE
Mailing Address - Street 2:VA NORTHERN INDIANA HEALTH CARE SYSTEM
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805
Mailing Address - Country:US
Mailing Address - Phone:260-426-5431
Mailing Address - Fax:765-213-2769
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:VA NORTHERN INDIANA HEALTH CARE SYSTEM
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805
Practice Address - Country:US
Practice Address - Phone:260-426-5431
Practice Address - Fax:765-213-2769
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004217A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily