Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | COA15691NP | OH |
NPI | 1063825537 |
---|---|
Provider Name | Christina Carpenter |
First Address | Canton, OH 44702-2165 |
Second Address | Canton, OH 44702-2165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 29/04/2020 |