Provider Demographics
NPI:1205719416
Name:CARTER, TAWANA SHARRISE
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:SHARRISE
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAWANA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 CHENE ST APT 321
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4967
Mailing Address - Country:US
Mailing Address - Phone:785-813-4077
Mailing Address - Fax:
Practice Address - Street 1:2021 CHENE ST APT 321
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4967
Practice Address - Country:US
Practice Address - Phone:785-813-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI163WC1500X163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health