Provider Demographics
NPI:1477531408
Name:CARNER, WREATHA (CNM)
Entity Type:Individual
Prefix:
First Name:WREATHA
Middle Name:
Last Name:CARNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:WREATHA
Other - Middle Name:
Other - Last Name:CARNER-RIEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1828 IMPERIAL RDG
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4812
Mailing Address - Country:US
Mailing Address - Phone:505-930-1323
Mailing Address - Fax:
Practice Address - Street 1:1828 IMPERIAL RDG
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4812
Practice Address - Country:US
Practice Address - Phone:505-930-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116407367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife