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NPI Code Detail

MEDICARE: JALESA CARTER

MEDICARE: JALESA 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
1164W00000XLicensed Practical Nurse333891NY

General Provider Information

NPI Number : 1619447505
Entity Type Code : Individual
Provider Name (Legal Business Name) : JALESA CARTER
Provider Business Mailing Address
First Line : 1707 MAHAN AVE
Second Line :
City : BRONX
State : NY
Zip : 10461-4905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1707 MAHAN AVE
Second Line :
City : BRONX
State : NY
Zip : 10461-4905
Country : US
Telephone Number : 862-591-6812
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2018
Last Update Date : 12/04/2018

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Directions to “ JALESA CARTER ” Practice Location

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