Provider Demographics
NPI:1457846222
Name:SENGER-CARPENTER, THEA ROSE (APRN)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:ROSE
Last Name:SENGER-CARPENTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:THEA
Other - Middle Name:ROSE
Other - Last Name:SENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:2095 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1833
Practice Address - Country:US
Practice Address - Phone:734-221-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00875000363LP0200X
NY382869363LP0200X
NY723823163W00000X
MI4704348100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse