Provider Demographics
NPI:1396865994
Name:CARPENTER, DEBORAH ARNETTE (LPN)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ARNETTE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 MILL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4109
Mailing Address - Country:US
Mailing Address - Phone:330-726-1424
Mailing Address - Fax:
Practice Address - Street 1:6640 MILL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4109
Practice Address - Country:US
Practice Address - Phone:330-726-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN034221164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2317272Medicaid