Individual
MINDY MARIE CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6703 LONDON RD, SOUTH CHARLESTON, OH 45368-9632
(937) 536-9436
Mailing address
6703 LONDON RD, SOUTH CHARLESTON, OH 45368-9632
(937) 536-9436
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1204789
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1204789
—
OH
Enumeration date
09/11/2020
Last updated
09/11/2020
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