Provider Demographics
NPI:1932700366
Name:CARPENTER, SHAWN JR
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:CARPENTER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 LONDON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368-9632
Mailing Address - Country:US
Mailing Address - Phone:937-624-2484
Mailing Address - Fax:
Practice Address - Street 1:1567 REGENT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-5967
Practice Address - Country:US
Practice Address - Phone:937-624-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker