MEDICARE: MRS. MOLLI CARPENTER STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	401050500310	OH

General Provider Information

NPI Number	:	1386921005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MOLLI CARPENTER STNA

Provider Business Mailing Address
First Line	:	54266 WALNUT RIDGE RD
Second Line	:
City	:	QUAKER CITY
State	:	OH
Zip	:	43773-9652
Country	:	US
Telephone Number	:	740-581-1145
Fax Number	:

Provider Business Practice Location Address
First Line	:	54266 WALNUT RIDGE RD
Second Line	:
City	:	QUAKER CITY
State	:	OH
Zip	:	43773-9652
Country	:	US
Telephone Number	:	740-581-1145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2011
Last Update Date	:	11/09/2011

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