Provider Demographics
NPI:1225588544
Name:CARTER, LISA MARY
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARY
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27951 WALTZ RD
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48164-9321
Mailing Address - Country:US
Mailing Address - Phone:313-978-3051
Mailing Address - Fax:
Practice Address - Street 1:27951 WALTZ RD
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:MI
Practice Address - Zip Code:48164-9321
Practice Address - Country:US
Practice Address - Phone:313-978-3051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other