Healthcare Provider Details

I. General information

NPI: 1578739751
Provider Name (Legal Business Name): NICOLE CHRISTINE CARTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E MARSHALL ST BOX 980102
RICHMOND VA
23298-5054
US

IV. Provider business mailing address

PO BOX 980102
RICHMOND VA
23298-0102
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-3144
  • Fax: 804-628-7104
Mailing address:
  • Phone: 804-828-3144
  • Fax: 804-628-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number0001199901
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167509
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: