Provider Demographics
NPI:1316242142
Name:CARPENTER, LINDA MARIE (CRNA)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2705
Mailing Address - Country:US
Mailing Address - Phone:906-225-3595
Mailing Address - Fax:877-775-5759
Practice Address - Street 1:3139 REVERE DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1642
Practice Address - Country:US
Practice Address - Phone:989-332-6120
Practice Address - Fax:989-791-2007
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247120367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered