MEDICARE: MRS. ELAINE DANIEL CARPENTER RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	073214	LA
2	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	073214	LA

General Provider Information

NPI Number	:	1033364922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELAINE DANIEL CARPENTER RN

Provider Business Mailing Address
First Line	:	2605 EMILY DR
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-5925
Country	:	US
Telephone Number	:	225-226-0395
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 EMILY DR
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-5925
Country	:	US
Telephone Number	:	225-226-0395
Fax Number	:

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

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	11/19/2008

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