Individual
DWIGHT CARPEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
390 SE 10TH ST, MADRAS, OR 97741-1573
(541) 383-3005
(541) 383-1883
Mailing address
PO BOX 4228, PORTLAND, OR 97208-4228
(541) 383-3005
(541) 383-1883
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
201602863NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500638726
—
OR
Enumeration date
11/03/2006
Last updated
10/24/2024
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