Provider Demographics
NPI:1043667637
Name:CARPENTER, NICHOLAS EUGENE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EUGENE
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 11TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6366
Mailing Address - Country:US
Mailing Address - Phone:206-616-4001
Mailing Address - Fax:206-616-3889
Practice Address - Street 1:4311 11TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6366
Practice Address - Country:US
Practice Address - Phone:206-616-4001
Practice Address - Fax:206-616-3889
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60804467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant