Active NPI
Denise Elaine Antle, ARNP, MSN, CCNS
- Critical Care Medicine Clinical Nurse Specialist
- Davenport, IA
National Provider Identifier
1689724700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine Clinical Nurse Specialist
- License
- 055474
- Practice address
- 1236 E Rusholme St
Davenport, IA 52803-2473 - Phone
- (563) 421-3994
- Fax
- (563) 421-3999
- NPI assigned
- Jan 11, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Clinical Nurse Specialist | 364SC0200X | 055474 | IA | Primary |
Addresses
Primary practice location
1236 E Rusholme St
Davenport, IA 52803-2473
Mailing address
815 Waverly Rd
Davenport, IA 52804-4330
Phone (563) 326-4499
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 506291 | Other | IOWA HEALTH SOLUTION | |
| 16064 | Other | IA | WELLMARK BCBS |
| 436543 | Medicaid | IA |
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)
- Enrolled
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055474 | IA | MD | Critical Care Medicine Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Health System | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689724700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "815 WAVERLY RD",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528044330",
"telephone_number": "563-326-4499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1236 E RUSHOLME ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528032473",
"telephone_number": "563-421-3994",
"fax_number": "563-421-3999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTLE",
"first_name": "DENISE",
"middle_name": "ELAINE",
"credential": "ARNP, MSN, CCNS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "364SC0200X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Critical Care Medicine",
"state": "IA",
"license": "055474",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IOWA HEALTH SOLUTION",
"identifier": "506291",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK BCBS",
"identifier": "16064",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "436543",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.