Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | NP712 | ID |
NPI | 1033154513 |
---|---|
Provider Name | Janice Carter |
First Address | Twin Falls, ID 83301-5306 |
Second Address | Twin Falls, ID 83301-5306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 03/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807194400 | (05) | ID |
Q49970 | (02) | ID |