MEDICARE: LISA M CARTER ARNP

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
1	363LA2200X	Adult Health Nurse Practitioner	4352P	KY
2	363LA2200X	Adult Health Nurse Practitioner	F309132	NY
3	363LG0600X	Gerontology Nurse Practitioner	4352P	KY
4	363LA2200X	Adult Health Nurse Practitioner	28158514A	IN

General Provider Information

NPI Number	:	1194722421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M CARTER ARNP

Provider Business Mailing Address
First Line	:	641 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4503
Country	:	US
Telephone Number	:	646-888-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	12/20/2019

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