Provider Demographics
NPI:1265673024
Name:ANTWI, JACQUELYN EUGENIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:EUGENIA
Last Name:ANTWI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 FOUNTAINVIEW CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2100
Mailing Address - Country:US
Mailing Address - Phone:614-598-0822
Mailing Address - Fax:
Practice Address - Street 1:1942 FOUNTAINVIEW CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2100
Practice Address - Country:US
Practice Address - Phone:614-598-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 339012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse