Provider Demographics
NPI:1144966086
Name:CARTER, WANETA JOHANNA (SNP-C)
Entity type:Individual
Prefix:MS
First Name:WANETA
Middle Name:JOHANNA
Last Name:CARTER
Suffix:
Gender:F
Credentials:SNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 S 83RD AVE # 100-259
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7206
Mailing Address - Country:US
Mailing Address - Phone:623-810-4270
Mailing Address - Fax:
Practice Address - Street 1:12630 N 103RD AVE STE 142
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3463
Practice Address - Country:US
Practice Address - Phone:480-275-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274297363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty