Provider Demographics
NPI:1578692265
Name:CARTER, VANESSA (CNA)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 FIRELANE RD
Mailing Address - Street 2:SUITE C-34
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7653
Mailing Address - Country:US
Mailing Address - Phone:803-404-7487
Mailing Address - Fax:
Practice Address - Street 1:7225 FIRELANE RD
Practice Address - Street 2:SUITE C-34
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7653
Practice Address - Country:US
Practice Address - Phone:803-404-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20881R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide