Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 209.014754 | IL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 209.014754 | IL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 209.014754 | IL |
NPI | 1073062154 |
---|---|
Provider Name | Ashley Carter |
First Address | Chicago, IL 60612-4325 |
Second Address | Chicago, IL 60612-4795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2016 |
Last Update Date | 19/03/2021 |