Basic Information
| Provider Information | |||||||||
| NPI: | 1285203968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | ELISABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 335 RIGHTERS FERRY RD APT 340 | ||||||||
| Address2: | |||||||||
| City: | BALA CYNWYD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190041746 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 W LANCASTER AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105201510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2021 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 725104 | PA | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LP0808X | 2022062450 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.