Provider Demographics
NPI:1275185811
Name:CARTER, JILLIAN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
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 1:122 MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-1605
Mailing Address - Country:US
Mailing Address - Phone:585-690-4997
Mailing Address - Fax:
Practice Address - Street 1:122 MANOR AVE
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-1605
Practice Address - Country:US
Practice Address - Phone:585-690-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY611736-1163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant