Individual
DIANE RUTH CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN-21303
Contact information
Practice address
2201 E 11TH ST, FARMINGTON, NM 87401-7570
(505) 801-4905
Mailing address
2201 E 11TH ST, FARMINGTON, NM 87401-7570
(505) 801-4905
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
LPN21303
NM
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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