Provider Demographics
NPI:1336845064
Name:CARTER, NICOLE ROSE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSE
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT MEADOWS
Mailing Address - State:NJ
Mailing Address - Zip Code:07838-2102
Mailing Address - Country:US
Mailing Address - Phone:908-652-1529
Mailing Address - Fax:
Practice Address - Street 1:25 HOPE RD
Practice Address - Street 2:
Practice Address - City:GREAT MEADOWS
Practice Address - State:NJ
Practice Address - Zip Code:07838-2102
Practice Address - Country:US
Practice Address - Phone:908-652-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT003202002255A2300X
PART0082232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer