Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 70-012209 | NY |
NPI | 1093062267 |
---|---|
Provider Name | Dr. Stacy Marie Carter |
First Address | Syracuse, NY 13205-2545 |
Second Address | Syracuse, NY 13205-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2012 |
Last Update Date | 02/09/2016 |