Healthcare Provider Details

I. General information

NPI: 1679014104
Provider Name (Legal Business Name): CORETTA ANTWI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 ROLFE SQ
CRANSTON RI
02910-3413
US

IV. Provider business mailing address

94 ROLFE SQ
CRANSTON RI
02910-3413
US

V. Phone/Fax

Practice location:
  • Phone: 401-837-6716
  • Fax:
Mailing address:
  • Phone: 401-837-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN01657
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN01657
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number48253
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: