Provider Demographics
NPI:1124190590
Name:CARTER, SHANA L (MS APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3129
Mailing Address - Country:US
Mailing Address - Phone:460-752-7441
Mailing Address - Fax:
Practice Address - Street 1:632 BROADWAY PH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2614
Practice Address - Country:US
Practice Address - Phone:800-731-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110580363LF0000X
MT120113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEMC0715980OtherFEDERAL DEA NUMBER