Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD60647806 | WA |
N | 207R00000X | Internist | MD60647806 | WA |
N | 111NI0900X | Internist | MD60647806 | WA |
NPI | 1043537426 |
---|---|
Provider Name | Dr. Carrie Nicole Caruthers |
First Address | Vancouver, WA 98664-1913 |
Second Address | Vancouver, WA 98686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 02/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2106171 | (05) | LA |