Healthcare Provider Details

I. General information

NPI: 1093711764
Provider Name (Legal Business Name): MARY ANNE CARTER C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DEGRANDPRE WAY
PLATTSBURGH NY
12901-6449
US

IV. Provider business mailing address

25 DEGRANDPRE WAY
PLATTSBURGH NY
12901-6449
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-3260
  • Fax: 518-561-2877
Mailing address:
  • Phone: 518-563-3260
  • Fax: 518-561-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF300505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: