Provider Demographics
NPI:1396454583
Name:CARTER, SKYLER NICOLE
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:NICOLE
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 1:11059 CRONK RD
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-9741
Mailing Address - Country:US
Mailing Address - Phone:989-494-2073
Mailing Address - Fax:
Practice Address - Street 1:1484 N M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1235
Practice Address - Country:US
Practice Address - Phone:770-373-5822
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC636768630437156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist