=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790912384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA A CARTER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2009
-----------------------------------------------------
Last Update Date | 01/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 G ST SUITE 208
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-5663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-741-1122
-----------------------------------------------------
Fax | 530-741-1155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3067
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95992-3067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-741-1122
-----------------------------------------------------
Fax | 530-741-1155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 581251
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------