Provider Demographics
NPI:1669968731
Name:CARTER, ERIN JEANINE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JEANINE
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 1:1500 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1052
Mailing Address - Country:US
Mailing Address - Phone:906-369-4572
Mailing Address - Fax:
Practice Address - Street 1:1500 BIRCH ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1052
Practice Address - Country:US
Practice Address - Phone:906-369-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI174H00000XOtherHEALTH EDUCATOR
MI174H00000XMedicaid