Provider Demographics
NPI:1578332763
Name:TRACY- CARTER, DANITA
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:
Last Name:TRACY- CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 NE FREEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3217
Mailing Address - Country:US
Mailing Address - Phone:916-823-1985
Mailing Address - Fax:
Practice Address - Street 1:1338 NE FREEMONT AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3217
Practice Address - Country:US
Practice Address - Phone:916-823-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR110252374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula