Provider Demographics
NPI:1336934603
Name:CARTER, MARIA VANESSA (SUDPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VANESSA
Last Name:CARTER
Suffix:
Gender:
Credentials:SUDPT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CARTER
Other - Last Name:SAUCIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-0196
Mailing Address - Country:US
Mailing Address - Phone:253-223-0406
Mailing Address - Fax:
Practice Address - Street 1:1715 S 324TH PL STE 250
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8581
Practice Address - Country:US
Practice Address - Phone:206-759-7783
Practice Address - Fax:206-501-4204
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61676875390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program