Provider Demographics
NPI:1932433950
Name:MOSHER-CARBIENER, CHARMAINE M (NP)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:M
Last Name:MOSHER-CARBIENER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4387
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-4387
Mailing Address - Country:US
Mailing Address - Phone:707-822-7220
Mailing Address - Fax:707-826-8214
Practice Address - Street 1:3798 JANES RD STE 20
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4746
Practice Address - Country:US
Practice Address - Phone:707-822-0384
Practice Address - Fax:707-822-4429
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2019-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP10751363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS84310Medicare UPIN