Healthcare Provider Details

I. General information

NPI: 1689041279
Provider Name (Legal Business Name): DARCI CARPENTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST
FLINT MI
48507-2677
US

IV. Provider business mailing address

4800 S SAGINAW ST
FLINT MI
48507-2677
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-8336
  • Fax: 810-963-1674
Mailing address:
  • Phone: 810-732-8336
  • Fax: 810-963-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704283946
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: