Healthcare Provider Details

I. General information

NPI: 1487163101
Provider Name (Legal Business Name): SHANEKQUA TIKEYA CARTER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 ROUTE 73
VOORHEES NJ
08043-9526
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-341-8474
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberGAA-CNM002342
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00062701
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: