Active NPI
Jacqueline Antepenko
- Registered Nurse
- Providence, RI
National Provider Identifier
1710763412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 2355554
- Practice address
- 830 Chalkstone Ave
Providence, RI 02908-4799 - Phone
- (401) 273-7100
- NPI assigned
- Sep 7, 2023
- Last updated
- Sep 7, 2023
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2355554 | MA | Primary |
Addresses
Primary practice location
830 Chalkstone Ave
Providence, RI 02908-4799
Mailing address
176 Reynolds Ave
Rehoboth, MA 02769-3015
Phone (508) 223-7611
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2355554 | MA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694044800000",
"number": "1710763412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "176 REYNOLDS AVE",
"city": "REHOBOTH",
"state": "MA",
"postal_code": "027693015",
"telephone_number": "508-223-7611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 CHALKSTONE AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029084799",
"telephone_number": "401-273-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTEPENKO",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-07",
"last_updated": "2023-09-07",
"certification_date": "2023-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MA",
"license": "2355554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.