MEDICARE: MISS LEAH M CARTER CNA

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	374U00000X	Home Health Aide
2	376K00000X	Nurse's Aide	CNA999952624	AZ

General Provider Information

NPI Number	:	1538450846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LEAH M CARTER CNA

Provider Business Mailing Address
First Line	:	1051 S DOBSON RD
Second Line	:	UNIT 18
City	:	MESA
State	:	AZ
Zip	:	85202-3903
Country	:	US
Telephone Number	:	480-259-2379
Fax Number	:	480-269-9686

Provider Business Practice Location Address
First Line	:	1051 S DOBSON RD
Second Line	:	UNIT 18
City	:	MESA
State	:	AZ
Zip	:	85202-3903
Country	:	US
Telephone Number	:	480-259-2379
Fax Number	:	480-269-9686

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

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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