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NPI Code Detail

MEDICARE: TIELLA MARIE CARTER

MEDICARE: TIELLA MARIE CARTER
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
1171M00000XCase Manager/Care CoordinatorOH

General Provider Information

NPI Number : 1912861113
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIELLA MARIE CARTER
Provider Business Mailing Address
First Line : 430 N BROADWAY ST
Second Line :
City : GREEN SPRINGS
State : OH
Zip : 44836-9734
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 430 N BROADWAY ST
Second Line :
City : GREEN SPRINGS
State : OH
Zip : 44836-9734
Country : US
Telephone Number : 888-767-8179
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2025
Last Update Date : 12/11/2025

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Directions to “ TIELLA MARIE CARTER ” Practice Location

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