1144966086 NPI number — MS. WANETA JOHANNA CARTER SNP-C

Table of content: MS. WANETA JOHANNA CARTER SNP-C (NPI 1144966086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144966086 NPI number — MS. WANETA JOHANNA CARTER SNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
WANETA
Provider Middle Name:
JOHANNA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144966086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2632 S 83RD AVE # 100-259
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85043-7206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-810-4270
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12630 N 103RD AVE STE 142
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85351-3463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-275-2022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  274297 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com