Provider Demographics
NPI:1427238039
Name:CARTER, DONNELL (CRNA)
Entity type:Individual
Prefix:
First Name:DONNELL
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3364
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3364
Practice Address - Fax:781-407-0998
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209023732367500000X
MA233987367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered