Healthcare Provider Details

I. General information

NPI: 1417667627
Provider Name (Legal Business Name): DENNAIA CARTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5397 TWIN KNOLLS RD STE 14
COLUMBIA MD
21045-3256
US

IV. Provider business mailing address

1115 CHEVRON RD
SEVERN MD
21144-2563
US

V. Phone/Fax

Practice location:
  • Phone: 240-391-3590
  • Fax:
Mailing address:
  • Phone: 240-653-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR213525
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: