Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 007491 | IA |
NPI | 1275801201 |
---|---|
Provider Name | Dr. Jacquellyn Jo Carter |
First Address | Eldridge, IA 52748-9637 |
Second Address | Eldridge, IA 52748-9637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2011 |
Last Update Date | 05/12/2011 |