Provider Demographics
NPI:1689918583
Name:CARTER, JULEEN LINDA (MED)
Entity Type:Individual
Prefix:MS
First Name:JULEEN
Middle Name:LINDA
Last Name:CARTER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 REDFERN DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4618
Mailing Address - Country:US
Mailing Address - Phone:585-271-4475
Mailing Address - Fax:
Practice Address - Street 1:30 REDFERN DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4618
Practice Address - Country:US
Practice Address - Phone:585-271-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY590921407OtherDRIVER'S LICENSE