Provider Demographics
NPI:1043828866
Name:VENDITTO, JENNA S (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:S
Last Name:VENDITTO
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 PROVIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:186 PROVIDENCE ST
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2508
Practice Address - Country:US
Practice Address - Phone:401-615-2800
Practice Address - Fax:401-615-2805
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAPRN02333OtherADVANCED PRACTICE REGISTERED NURSE
RIRN52895OtherREGISTERED NURSE
MV5990519OtherDRUG ENFORCEMENT ADMINISTRATION