Provider Demographics
NPI:1720144777
Name:CARTER, NICOLETTE (LMP)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18524 9TH ST E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6401
Mailing Address - Country:US
Mailing Address - Phone:253-223-3138
Mailing Address - Fax:
Practice Address - Street 1:706 MARKET ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3712
Practice Address - Country:US
Practice Address - Phone:253-223-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0201330OtherL & I NUMBER