Provider Demographics
NPI:1720854227
Name:FOSTER, NOLISHA (APRN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NOLISHA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:APRN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4668 ROYAL COVE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1500
Mailing Address - Country:US
Mailing Address - Phone:586-329-8920
Mailing Address - Fax:
Practice Address - Street 1:31300 NORTHWESTERN HWY STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5407
Practice Address - Country:US
Practice Address - Phone:248-254-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704348488363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health