Provider Demographics
NPI:1043034325
Name:FOSTER-JOHNSON, THERESA GAIL
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:GAIL
Last Name:FOSTER-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BROOKLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3157
Mailing Address - Country:US
Mailing Address - Phone:567-686-7369
Mailing Address - Fax:
Practice Address - Street 1:821 BROOKLEY BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-3157
Practice Address - Country:US
Practice Address - Phone:567-686-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide