Provider Demographics
NPI:1740953264
Name:CARPENTER, SAMANTHA (RN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:FURTAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:313 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:DE
Mailing Address - Zip Code:19730-2078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 S 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:DE
Practice Address - Zip Code:19730-2078
Practice Address - Country:US
Practice Address - Phone:302-378-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE108879163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool