Provider Demographics
NPI:1699984203
Name:CARPENTER, MARY ELLEN (CNM, FNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70368
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0120
Mailing Address - Country:US
Mailing Address - Phone:541-349-7600
Mailing Address - Fax:541-686-8330
Practice Address - Street 1:1902 JEFFERSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2414
Practice Address - Country:US
Practice Address - Phone:541-284-8882
Practice Address - Fax:541-284-2826
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000030956N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily