Provider Demographics
NPI:1932217494
Name:CARTER, DORIS ANN (ANP)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:ANN
Last Name:CARTER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 OLD GLENN HWY
Mailing Address - Street 2:STE A
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7598
Mailing Address - Country:US
Mailing Address - Phone:907-696-5680
Mailing Address - Fax:907-696-5688
Practice Address - Street 1:12320 OLD GLENN HWY
Practice Address - Street 2:STE A
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7598
Practice Address - Country:US
Practice Address - Phone:907-696-5680
Practice Address - Fax:907-696-5688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP03642Medicaid
AKNP03642Medicaid
AKK153313Medicare PIN