Provider Demographics
NPI:1518476647
Name:CARTER, SEQUILLA (APRN)
Entity Type:Individual
Prefix:DR
First Name:SEQUILLA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 CROSSROADS PLZ UNIT 370236
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06137-7711
Mailing Address - Country:US
Mailing Address - Phone:504-450-6769
Mailing Address - Fax:504-226-0460
Practice Address - Street 1:3 BARNARD LN STE 311
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2495
Practice Address - Country:US
Practice Address - Phone:860-458-4759
Practice Address - Fax:504-226-0721
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI65000163W00000X
CT166902163W00000X
MARN2361143363LP0808X
CT8679363LP0808X
LA95520163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse