Provider Demographics
NPI:1447561675
Name:CARPENTER, AUDREY SAMANTHA
Entity type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:SAMANTHA
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 MOUNT AUBURN AVE
Mailing Address - Street 2:DOWNSTAIRS
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-4751
Mailing Address - Country:US
Mailing Address - Phone:216-539-6720
Mailing Address - Fax:
Practice Address - Street 1:9405 MOUNT AUBURN AVE
Practice Address - Street 2:DOWNSTAIRS
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-4751
Practice Address - Country:US
Practice Address - Phone:216-539-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program