Provider Demographics
NPI:1225740475
Name:CARTER, TARA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 38TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2518
Mailing Address - Country:US
Mailing Address - Phone:417-569-0656
Mailing Address - Fax:
Practice Address - Street 1:51 NEWARK ST STE 404C
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4543
Practice Address - Country:US
Practice Address - Phone:417-569-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720544163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant