Provider Demographics
NPI:1629199039
Name:CARPENTER, KAREN SUE IV
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:CARPENTER
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1825
Mailing Address - Country:US
Mailing Address - Phone:260-563-0875
Mailing Address - Fax:260-563-1117
Practice Address - Street 1:762 N SPRING ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1825
Practice Address - Country:US
Practice Address - Phone:260-563-0875
Practice Address - Fax:260-563-1117
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist