Provider Demographics
NPI:1053514711
Name:CARPENTER, EILEEN POLT (CRNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:POLT
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:POLT
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:85 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2544
Mailing Address - Country:US
Mailing Address - Phone:610-688-3744
Mailing Address - Fax:610-688-4490
Practice Address - Street 1:85 OLD EAGLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:19087-2544
Practice Address - Country:US
Practice Address - Phone:610-688-3744
Practice Address - Fax:610-688-4490
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP002251G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP002251GOtherSTATE LICENSE
S60847Medicare UPIN