=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891632402
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANETA RODERICK RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2026
-----------------------------------------------------
Last Update Date | 05/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49 HARRY KEMP WAY
-----------------------------------------------------
City | PROVINCETOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-487-9395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 NAUSET GREEN WAY
-----------------------------------------------------
City | EASTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-237-6105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Registered Nurse
-----------------------------------------------------
License Number | RN10009403
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------