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General NPI Number Information
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NPI Number | 1871929471
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Entity Type | Individual
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Provider Name | LISA JUNE CARTER NP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 802 KENYON RD
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City | FORT DODGE
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State | IA
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Zip | 50501-5740
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Country | US
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Telephone | 515-573-3101
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Fax |
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Provider Business Mailing Address
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Address Line | 401 STATE ST
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City | EMMETSBURG
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State | IA
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Zip | 50536-1266
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Country | US
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Telephone | 712-852-9404
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | L103874
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License Number State | IA
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