Individual
MASON CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
21 N FISHER PARK WAY, EAGLE, ID 83616-4796
(208) 514-0670
Mailing address
1300 N PENN STATION LN APT 201, MERIDIAN, ID 83642-9428
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53832
ID
Other
Enumeration date
11/11/2019
Last updated
11/11/2019
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