Provider Demographics
NPI:1689913329
Name:CARTER, JILL A (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:A
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 STATE AVE
Mailing Address - Street 2:#103
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3612
Mailing Address - Country:US
Mailing Address - Phone:360-659-9659
Mailing Address - Fax:360-548-4057
Practice Address - Street 1:1241 STATE AVE
Practice Address - Street 2:#103
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3612
Practice Address - Country:US
Practice Address - Phone:360-659-9659
Practice Address - Fax:360-548-4057
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist