Provider Demographics
NPI:1245815885
Name:CARPENTER, CINDY LOU (MA/LPN)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LOU
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MA/LPN
Other - Prefix:MRS
Other - First Name:CINDYLOU
Other - Middle Name:
Other - Last Name:NESBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/LPN
Mailing Address - Street 1:711 WATERLOO GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1206
Mailing Address - Country:US
Mailing Address - Phone:315-909-4868
Mailing Address - Fax:
Practice Address - Street 1:711 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1206
Practice Address - Country:US
Practice Address - Phone:315-909-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010081981163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY895822287OtherDRIVER ID