Basic Information
| Provider Information | |||||||||
| NPI: | 1043343379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLARNON | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SILVA | ||||||||
| OtherFirstName: | ROSE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25 BLACKSTONE VALLEY PLACE | ||||||||
| Address2: | SUITE 300 FELLOWSHIP HEALTH RESOURCES INC | ||||||||
| City: | LINCOLN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028651163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013333980 | ||||||||
| FaxNumber: | 4013333984 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 HOPE STREET | ||||||||
| Address2: | HOPE STREET APARTMENTS | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029062173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013518833 | ||||||||
| FaxNumber: | 4012748210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN43512 | RI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | RM62942 | 05 | RI | MEDICAID |