Provider Demographics
NPI:1639824642
Name:CARTER, DAN (FNPC)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:FNPC
Other - Prefix:MR
Other - First Name:SALAH
Other - Middle Name:
Other - Last Name:ELSHEKH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:14053 N RIVER BRANCH TRL
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4952
Mailing Address - Country:US
Mailing Address - Phone:909-697-0250
Mailing Address - Fax:909-697-0260
Practice Address - Street 1:14053 N RIVER BRANCH TRL
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4952
Practice Address - Country:US
Practice Address - Phone:909-697-0250
Practice Address - Fax:909-697-0260
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ275531363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner