Provider Demographics
NPI:1982182291
Name:CARPENTER, SHANIQUE DENISE
Entity Type:Individual
Prefix:
First Name:SHANIQUE
Middle Name:DENISE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 COALFIRE AVE
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-1208
Mailing Address - Country:US
Mailing Address - Phone:205-306-3661
Mailing Address - Fax:
Practice Address - Street 1:704 COALFIRE AVE
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1208
Practice Address - Country:US
Practice Address - Phone:205-306-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide