Provider Demographics
NPI:1780938498
Name:CARTER, NICOLE DIANE (CNP)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:DIANE
Last Name:CARTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 HAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1110
Mailing Address - Country:US
Mailing Address - Phone:330-743-0700
Mailing Address - Fax:
Practice Address - Street 1:878 COITSVILLE HUBBARD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4635
Practice Address - Country:US
Practice Address - Phone:330-743-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12666363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care