Healthcare Provider Details

I. General information

NPI: 1336934603
Provider Name (Legal Business Name): MARIA VANESSA CARTER SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA CARTER SAUCIER CNA

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 S 324TH PL STE 250
FEDERAL WAY WA
98003-8581
US

IV. Provider business mailing address

PO BOX 196
SPANAWAY WA
98387-0196
US

V. Phone/Fax

Practice location:
  • Phone: 206-759-7783
  • Fax: 206-501-4204
Mailing address:
  • Phone: 253-223-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO61676875
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: