Provider Demographics
NPI:1740505437
Name:CARPENTER, JULIE (FNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-9694
Mailing Address - Country:US
Mailing Address - Phone:315-638-6055
Mailing Address - Fax:315-635-3970
Practice Address - Street 1:29 E ONEIDA ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2480
Practice Address - Country:US
Practice Address - Phone:315-638-6018
Practice Address - Fax:315-635-3970
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332597-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily