Provider Demographics
NPI:1629185087
Name:CARPENTER, DIANA L (NP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 N STATE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1297
Mailing Address - Country:US
Mailing Address - Phone:315-376-5287
Mailing Address - Fax:315-376-3228
Practice Address - Street 1:7785 N STATE ST FL 3
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1297
Practice Address - Country:US
Practice Address - Phone:315-376-5287
Practice Address - Fax:315-376-3228
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S90129Medicare UPIN
DD0159Medicare ID - Type Unspecified