Healthcare Provider Details

I. General information

NPI: 1588013700
Provider Name (Legal Business Name): GWENDOLYN CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 I ST
LAS VEGAS NV
89106-2929
US

IV. Provider business mailing address

1201 I STREET
LAS VEGAS NV
89106
US

V. Phone/Fax

Practice location:
  • Phone: 702-581-9540
  • Fax: 702-333-4480
Mailing address:
  • Phone: 702-581-9540
  • Fax: 702-333-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: