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General NPI Number Information
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NPI Number | 1336934603
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Entity Type | Individual
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Provider Name | MARIA VANESSA CARTER SUDPT
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Gender | Female
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 1715 S 324TH PL STE 250
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8581
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Country | US
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Telephone | 206-759-7783
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Fax | 206-501-4204
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Provider Business Mailing Address
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Address Line | PO BOX 196
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City | SPANAWAY
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State | WA
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Zip | 98387-0196
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Country | US
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Telephone | 253-223-0406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | CO61676875
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License Number State | WA
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