Provider Demographics
NPI:1215430095
Name:CARTER, DEIDRE M (BSN, RN)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 OLIVER AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-3245
Mailing Address - Country:US
Mailing Address - Phone:757-494-1796
Mailing Address - Fax:
Practice Address - Street 1:1757 OLIVER AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3245
Practice Address - Country:US
Practice Address - Phone:757-494-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care