Individual
AUDREY CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17311 108TH AVE, JAMAICA, NY 11433
(718) 657-6986
Mailing address
17311 108TH AVE, JAMAICA, NY 11433
(718) 657-6986
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
404405060
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
404405060
DRIVER LICENSE
NY
Enumeration date
10/18/2016
Last updated
10/18/2016
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