Provider Demographics
NPI:1922765841
Name:CARTER, PRECIOUS CHERETTA (CERTIFIED NURSE AID)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:CHERETTA
Last Name:CARTER
Suffix:
Gender:F
Credentials:CERTIFIED NURSE AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-0431
Mailing Address - Country:US
Mailing Address - Phone:720-883-8503
Mailing Address - Fax:
Practice Address - Street 1:10143 HIGHLAND MEADOW CIR APT 103
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9399
Practice Address - Country:US
Practice Address - Phone:720-883-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide