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NPI Code Detail

MEDICARE: PRINCESS IANA NIOMI CARTER

MEDICARE: PRINCESS IANA NIOMI CARTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1043907579
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRINCESS IANA NIOMI CARTER
Provider Business Mailing Address
First Line : 3624 RUSSIAN OLIVE ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-7643
Country : US
Telephone Number : 702-353-1079
Fax Number :
Provider Business Practice Location Address
First Line : 3624 RUSSIAN OLIVE ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-7643
Country : US
Telephone Number : 702-353-1079
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2023
Last Update Date : 04/24/2023

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Directions to “ PRINCESS IANA NIOMI CARTER ” Practice Location

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