Provider Demographics
NPI:1669094652
Name:WANAMAKER, CARTER LYNNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:LYNNE
Last Name:WANAMAKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CARTER
Other - Middle Name:LYNNE
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 GLENBOURNE CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3205
Mailing Address - Country:US
Mailing Address - Phone:317-427-3599
Mailing Address - Fax:
Practice Address - Street 1:29 GLENBOURNE CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3205
Practice Address - Country:US
Practice Address - Phone:317-427-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711035163W00000X
NY345457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse