Provider Demographics
NPI:1417324757
Name:CARPENTER, ERICA RENAE
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:RENAE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:RENAE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13923 S HAYSTACK PEAK CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6453
Mailing Address - Country:US
Mailing Address - Phone:801-506-6695
Mailing Address - Fax:
Practice Address - Street 1:13923 S HAYSTACK PEAK CIR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6453
Practice Address - Country:US
Practice Address - Phone:801-506-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist