Individual
MR. DERREK CARTER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
8027 W BECKETT AVE, MILWAUKEE, WI 53218-4626
(414) 202-1974
Mailing address
8027 W BECKETT AVE, MILWAUKEE, WI 53218-4626
(414) 202-1974
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
303122-31
WI
Other
Enumeration date
01/12/2017
Last updated
01/12/2017
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