Provider Demographics
NPI:1831702901
Name:CARTER, CHARLOTTE (RN)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:NM
Mailing Address - Zip Code:88426-0303
Mailing Address - Country:US
Mailing Address - Phone:806-679-1195
Mailing Address - Fax:
Practice Address - Street 1:7TH AND ELM ST
Practice Address - Street 2:
Practice Address - City:SAN JON
Practice Address - State:NM
Practice Address - Zip Code:88434
Practice Address - Country:US
Practice Address - Phone:575-576-2466
Practice Address - Fax:575-576-2772
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55479163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool