Provider Demographics
NPI:1164246989
Name:CARPENTER, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ANTONUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:CASE MANAGEMENT DEPT.
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708
Mailing Address - Country:US
Mailing Address - Phone:757-445-4366
Mailing Address - Fax:757-444-8541
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:CASE MANAGEMENT DEPT.
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2197
Practice Address - Country:US
Practice Address - Phone:757-445-4366
Practice Address - Fax:757-444-8541
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA78344163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management