Individual
ANDREA CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
659 BOULEVARD ST, DOVER, OH 44622-2026
(330) 364-0894
Mailing address
1551 TOMAHAWK LN, COSHOCTON, OH 43812-3118
(740) 502-0022
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19156
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19156
COA
OH
Enumeration date
05/31/2016
Last updated
05/31/2016
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