Most Relevant Information
Provider Data
| NPI Number: | 1003274846 |
| Provider Name: | SHANNON GAYLE FOSTER |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/08/2016 |
| Last Updated: | 02/08/2016 |
Provider Practice Location
2960 W ADAMS RD
PENTWATER
MI
494498579
Practice Location Phone/Fax
| Phone: | 2319236167 |
| Fax: |
Provider Mailing Location
2960 W ADAMS RD
PENTWATER
MI
494498579
Provider Mailing Phone/Fax
| Phone: | 2319236167 |
| Fax: |