Active NPI
Wibie S Altidor, RN
- Registered Nurse
- Brockton, MA
National Provider Identifier
1427560796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN10008490
- Practice address
- 40 Herrod Ave Unit 1
Brockton, MA 02301-2359 - Phone
- (781) 883-6172
- NPI assigned
- Oct 26, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN10008490 | MA | Primary |
| Licensed Practical Nurse | 164W00000X | LN9400 | MA |
Addresses
Primary practice location
40 Herrod Ave Unit 1
Brockton, MA 02301-2359
Mailing address
40 Herrod Ave Unit 1
Brockton, MA 02301-2359
Phone (781) 883-6172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN10008490 | MA | MD | Registered Nurse |
| LN9400 | MA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779321600000",
"number": "1427560796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 HERROD AVE UNIT 1",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023012359",
"telephone_number": "781-883-6172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 HERROD AVE UNIT 1",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023012359",
"telephone_number": "781-883-6172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALTIDOR",
"first_name": "WIBIE",
"middle_name": "S",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-26",
"last_updated": "2026-05-21",
"certification_date": "2026-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MA",
"license": "RN10008490",
"primary": true
},
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MA",
"license": "LN9400",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.