Provider Demographics
NPI:1548761497
Name:CARTER, GERALDINE P (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:P
Last Name:CARTER
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:GIGI
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1832
Mailing Address - Country:US
Mailing Address - Phone:601-201-5486
Mailing Address - Fax:
Practice Address - Street 1:12 LEEWARD LN
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8622
Practice Address - Country:US
Practice Address - Phone:601-201-5486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60823419133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist