Healthcare Provider Details

I. General information

NPI: 1811512072
Provider Name (Legal Business Name): ANNABEL JENG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2020
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQ
PROVIDENCE RI
02904-2709
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-6339
  • Fax: 401-453-6290
Mailing address:
  • Phone: 401-780-2511
  • Fax: 401-780-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95013786
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02514
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: