Provider Demographics
NPI:1639857832
Name:CARTER, ANDREA VIRGINIA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:VIRGINIA
Last Name: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 1:1825 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4080
Mailing Address - Country:US
Mailing Address - Phone:443-429-8152
Mailing Address - Fax:410-862-0823
Practice Address - Street 1:1825 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4080
Practice Address - Country:US
Practice Address - Phone:443-429-8152
Practice Address - Fax:410-862-0823
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR237762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse