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General NPI Number Information
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NPI Number | 1891668927
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Entity Type | Individual
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Provider Name | BREANNA NICOLE CARPENTER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 234 WENTWORTH AVE E
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City | WEST ST PAUL
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State | MN
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Zip | 55118-3525
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Country | US
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Telephone | 651-788-4444
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Fax | 651-455-3354
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Provider Business Mailing Address
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Address Line | 2025 SLOAN PL STE 35
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City | SAINT PAUL
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State | MN
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Zip | 55117-2092
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Country | US
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Telephone | 651-772-1572
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Fax | 651-772-1889
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2490039
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License Number State | MN
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