Provider Demographics
NPI:1952844862
Name:CARPER, STEPHANIE (CNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CARPER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4482
Mailing Address - Country:US
Mailing Address - Phone:401-728-9206
Mailing Address - Fax:
Practice Address - Street 1:59 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4482
Practice Address - Country:US
Practice Address - Phone:401-728-9206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308150363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics