Provider Demographics
NPI:1497063143
Name:CARPENTER, DEBORAH (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6290 JUPITER AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8884
Mailing Address - Country:US
Mailing Address - Phone:616-301-2500
Mailing Address - Fax:616-301-2501
Practice Address - Street 1:6290 JUPITER AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8884
Practice Address - Country:US
Practice Address - Phone:616-301-2500
Practice Address - Fax:616-301-2501
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205210163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse