Provider Demographics
NPI:1780198374
Name:CARTER, DEBORAH LYNN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
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 1:5608 VAN RD
Mailing Address - Street 2:
Mailing Address - City:MARSING
Mailing Address - State:ID
Mailing Address - Zip Code:83639-8182
Mailing Address - Country:US
Mailing Address - Phone:208-880-6232
Mailing Address - Fax:
Practice Address - Street 1:5608 VAN RD
Practice Address - Street 2:
Practice Address - City:MARSING
Practice Address - State:ID
Practice Address - Zip Code:83639-8182
Practice Address - Country:US
Practice Address - Phone:208-880-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide