Provider Demographics
NPI:1740379791
Name:CARPENTER, COLLEEN K (APRN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:K
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:402-328-3770
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592301Medicaid
NE47070592302Medicaid
NE47070592306Medicaid
NE10026072600Medicaid
NE10026072500Medicaid
NE47070592313Medicaid
NE47070592305Medicaid
NE47070592300Medicaid
NE280569Medicare PIN
Q73791Medicare UPIN
NE47070592302Medicaid
NE47070592305Medicaid
NENA1080029Medicare PIN
NEP00375000Medicare PIN