Provider Demographics
NPI:1770723033
Name:CARTER, JENNIFER KULEMIN (RAS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KULEMIN
Last Name:CARTER
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 COLD SPRINGS RD STE A
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4237
Mailing Address - Country:US
Mailing Address - Phone:530-642-1715
Mailing Address - Fax:530-642-2064
Practice Address - Street 1:2914 COLD SPRINGS RD STE A
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4237
Practice Address - Country:US
Practice Address - Phone:530-642-1715
Practice Address - Fax:530-642-2064
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-C0902241245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist