Provider Demographics
NPI:1093711764
Name:CARTER, MARY ANNE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:CARTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DEGRANDPRE WAY
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6449
Mailing Address - Country:US
Mailing Address - Phone:518-563-3260
Mailing Address - Fax:518-561-2877
Practice Address - Street 1:25 DEGRANDPRE WAY
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6449
Practice Address - Country:US
Practice Address - Phone:518-563-3260
Practice Address - Fax:518-561-2877
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300505363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01461018Medicaid
NY33569IMedicare ID - Type UnspecifiedMEDICARE NUMBER
NY01461018Medicaid