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NPI Code Detail

MEDICARE: NIKKI SHAUNAE CARTER RN

MEDICARE: NIKKI SHAUNAE CARTER RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NursePN. 130071OH
2163W00000XRegistered NurseRN.460301OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629200266
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKKI SHAUNAE CARTER RN
Provider Business Mailing Address
First Line : 615 ELSINORE PL STE 200
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1459
Country : US
Telephone Number : 513-834-7063
Fax Number :
Provider Business Practice Location Address
First Line : 580 PARK AVE W
Second Line :
City : MANSFIELD
State : OH
Zip : 44906-3722
Country : US
Telephone Number : 513-834-7063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2009
Last Update Date : 01/19/2021

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