Provider Demographics
NPI:1578818266
Name:CARTER, REBECCA ERIN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ERIN
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 PACIFIC AVE SE STE D
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2087
Mailing Address - Country:US
Mailing Address - Phone:253-241-5730
Mailing Address - Fax:
Practice Address - Street 1:2413 PACIFIC AVE SE STE D
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2087
Practice Address - Country:US
Practice Address - Phone:253-241-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA.60283764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist