Provider Demographics
NPI:1437381902
Name:CARRETHERS, PETER K (LPN)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:K
Last Name:CARRETHERS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-3103
Mailing Address - Country:US
Mailing Address - Phone:631-740-0583
Mailing Address - Fax:
Practice Address - Street 1:41 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-3103
Practice Address - Country:US
Practice Address - Phone:631-740-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295717-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse