Provider Demographics
NPI:1811395783
Name:CARPENTER, HOLLY (CNM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 8TH AVE STE 6020
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2319
Mailing Address - Country:US
Mailing Address - Phone:509-455-5050
Mailing Address - Fax:509-624-5034
Practice Address - Street 1:105 W 8TH AVE STE 6020
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2319
Practice Address - Country:US
Practice Address - Phone:509-455-5050
Practice Address - Fax:509-624-5034
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1491367A00000X
WAAP61120945367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2173045Medicaid