Provider Demographics
NPI:1477694347
Name:CARPENTER, CHERYL DENISE (LVN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:DENISE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:1774 ZONAL AVE # RTP-D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1063
Mailing Address - Country:US
Mailing Address - Phone:323-992-4323
Mailing Address - Fax:
Practice Address - Street 1:1774 ZONAL AVE # RTP-D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1063
Practice Address - Country:US
Practice Address - Phone:323-992-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180389164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180389OtherLICENSE