Healthcare Provider Details

I. General information

NPI: 1770905226
Provider Name (Legal Business Name): EBONY DOMINAQUE CARTER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 LEE RD
SHAKER HEIGHTS OH
44120-3649
US

IV. Provider business mailing address

3435 LEE RD
SHAKER HEIGHTS OH
44120-3649
US

V. Phone/Fax

Practice location:
  • Phone: 216-752-9090
  • Fax: 216-752-9080
Mailing address:
  • Phone: 216-752-9090
  • Fax: 216-752-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0027466
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0027466
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.413108
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN138244
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: