Provider Demographics
NPI:1912735606
Name:CARPENTER, CLOE JAY
Entity type:Individual
Prefix:
First Name:CLOE
Middle Name:JAY
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9545
Mailing Address - Country:US
Mailing Address - Phone:530-351-2449
Mailing Address - Fax:
Practice Address - Street 1:1142 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9545
Practice Address - Country:US
Practice Address - Phone:530-351-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula