Basic Information
| Provider Information | |||||||||
| NPI: | 1417551763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RT RCIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | CLARKS SUMMIT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184111923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705875937 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 E END BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187110030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708243521 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2020 | ||||||||
| LastUpdateDate: | 11/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246XC2901X | 00035990 | N | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Cardiovascular | Cardiovascular Invasive Specialist | 2471C1101X | 356107 | PA | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Cardiovascular-Interventional Technology |
No ID Information.