MEDICARE: EBONY DOMINAQUE CARTER NP-C

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	163W00000X	Registered Nurse	RN.413108	OH
2	363LG0600X	Gerontology Nurse Practitioner	APRN.CNP.0027466	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0027466	OH
4	164W00000X	Licensed Practical Nurse	PN138244	OH

General Provider Information

NPI Number	:	1770905226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY DOMINAQUE CARTER NP-C

Provider Business Mailing Address
First Line	:	3435 LEE RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-3649
Country	:	US
Telephone Number	:	216-752-9090
Fax Number	:	216-752-9080

Provider Business Practice Location Address
First Line	:	3435 LEE RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-3649
Country	:	US
Telephone Number	:	216-752-9090
Fax Number	:	216-752-9080

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

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	02/10/2026

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