Individual
MISS GRACE LAUREN CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 850-6441
Mailing address
4028 HARRISON CREEK CT, MISHAWAKA, IN 46544-9159
(574) 850-6441
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
45021866A
IN
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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