Provider Demographics
NPI:1013750850
Name:CARTER, DELONTE ANTWON (LPN)
Entity type:Individual
Prefix:
First Name:DELONTE
Middle Name:ANTWON
Last Name:CARTER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 COMO ST
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1231
Mailing Address - Country:US
Mailing Address - Phone:330-502-5415
Mailing Address - Fax:
Practice Address - Street 1:301 COMO ST
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1231
Practice Address - Country:US
Practice Address - Phone:330-502-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.165915164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse