Provider Demographics
NPI:1851790133
Name:CARTER, VALERIE (LPN)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 ROCKET ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4102
Mailing Address - Country:US
Mailing Address - Phone:585-413-1528
Mailing Address - Fax:585-413-1528
Practice Address - Street 1:267 ROCKET ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4102
Practice Address - Country:US
Practice Address - Phone:585-413-1528
Practice Address - Fax:585-413-1528
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201095-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02-362-123Medicaid