Coretta Antwi, NP
Individual provider Active NPI Adult Health Nurse Practitioner · Cranston, RI
NPI 1679014104 · NPPES record last updated Jan 24, 2024
Key facts
- NPI
- 1679014104
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- APRN01657 (RI)
- Practice address
- 94 Rolfe SQ
Cranston, RI 02910-3413 - Phone
- (401) 837-6716
- NPI assigned
- Mar 16, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lifespan Physician Group Inc
Practice addresses (Care Compare)
593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201022002877 | RI | Practitioner - Nurse Practitioner | 2163842576 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48253 | RI | MD | Registered Nurse |
| APRN01657 | RI | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beyond Beauty Medspa Ri LLP | Multi-Specialty | Current | Accepting new patients |
| Lifespan Physician Group, Inc. | Multi-Specialty | Current |
Accepting new patients |
| Lifespan Physician Group, Inc. | Multi-Specialty | Current |
Accepting new patients |
Locations
185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050
117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318
593 Eddy St
Providence, RI 02903
164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 48253 | RI | |
| Gerontology Nurse Practitioner | 363LG0600X | APRN01657 | RI | |
| Adult Health Nurse Practitioner |
363LA2200X | APRN01657 | RI | Yes |
Addresses
Primary practice location
94 Rolfe SQ
Cranston, RI 02910-3413
Mailing address
94 Rolfe SQ
Cranston, RI 02910-3413
Phone (401) 837-6716
Other practice location 1
593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-5520
Other providers in Cranston, RI
- James Andriotis
- Elizabeth Angell
- Kristine M Angell
- Angels Home Care LLC
- Kia Antoine
- Vanessa Apostolou
- Ara-Cranston Dialysis LLC
- Francine Angela Archambault
- Julie Arena-Brooks
- Cassondra M Arena
All providers in Cranston, RI · Adult Health Nurse Practitioner in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.