Provider Demographics
NPI:1639107303
Name:CARPENTER, SUSAN ELAINE (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELAINE
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 1:27 WALKING HORSE LN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-5072
Mailing Address - Country:US
Mailing Address - Phone:708-865-7917
Mailing Address - Fax:
Practice Address - Street 1:3931 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3413
Practice Address - Country:US
Practice Address - Phone:404-728-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN083881163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management