Provider Demographics
NPI:1194078329
Name:CARPENTER, MARY CATHERINE (MSN CNM)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MSN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GLEN COVE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4232
Mailing Address - Country:US
Mailing Address - Phone:207-301-8900
Mailing Address - Fax:207-301-5296
Practice Address - Street 1:3 GLEN COVE DR STE 1
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4232
Practice Address - Country:US
Practice Address - Phone:207-301-8900
Practice Address - Fax:207-301-5296
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282312163WN0002X, 367A00000X
MECNM122005367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110095013/AMedicaid
MA110095013/AMedicaid