Provider Demographics
NPI:1417588591
Name:CARPENTER, ERIN LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEIGH
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LEIGH
Other - Last Name:KANGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:97 S 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2168
Mailing Address - Country:US
Mailing Address - Phone:906-228-9699
Mailing Address - Fax:888-977-2109
Practice Address - Street 1:100 MALTON RD STE 7
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2002
Practice Address - Country:US
Practice Address - Phone:906-228-9699
Practice Address - Fax:888-977-2109
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282067163WH0200X, 163W00000X, 363LF0000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1033864954OtherGREAT LAKES RECOVERY CENTERS, INC
MI1417588591Medicaid