Provider Demographics
NPI:1417358623
Name:CARPENTER, REBECCA JOYCE (APNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOYCE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JOYCE
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:889 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-2933
Mailing Address - Country:US
Mailing Address - Phone:920-367-6700
Mailing Address - Fax:262-700-4657
Practice Address - Street 1:889 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2933
Practice Address - Country:US
Practice Address - Phone:920-367-6700
Practice Address - Fax:262-700-4657
Is Sole Proprietor?:No
Enumeration Date:2014-09-07
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5968 - 33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily