Healthcare Provider Details

I. General information

NPI: 1871929471
Provider Name (Legal Business Name): LISA JUNE CARTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 KENYON RD
FORT DODGE IA
50501-5740
US

IV. Provider business mailing address

401 STATE ST
EMMETSBURG IA
50536-1266
US

V. Phone/Fax

Practice location:
  • Phone: 515-573-3101
  • Fax:
Mailing address:
  • Phone: 712-852-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberL103874
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: