Provider Demographics
NPI:1952656506
Name:CARPENTER, ROBERT LEE (RN, MASSAGE TPST)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:RN, MASSAGE TPST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ATTLA WAY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7736
Mailing Address - Country:US
Mailing Address - Phone:907-598-4263
Mailing Address - Fax:
Practice Address - Street 1:610 ATTLA WAY
Practice Address - Street 2:SUITE 10
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7736
Practice Address - Country:US
Practice Address - Phone:907-598-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK28163163W00000X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163W00000XNursing Service ProvidersRegistered Nurse