Basic Information
| Provider Information | |||||||||
| NPI: | 1902953086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | GLEBA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MN, RN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12106 LANDINGS BLVD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21811 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6085 MARSHALEE DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ELKRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210756023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025595627 | ||||||||
| FaxNumber: | 4103793591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | LG-0000344 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AC000236 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.