Provider Demographics
NPI:1003901497
Name:ROSE, MARY (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY ELLEN
Other - Middle Name:
Other - Last Name:HOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:186 PROVIDENCE STREET
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893
Mailing Address - Country:US
Mailing Address - Phone:401-767-4100
Mailing Address - Fax:
Practice Address - Street 1:186 PROVIDENCE STREET
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893
Practice Address - Country:US
Practice Address - Phone:401-767-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00622363LP0808X
RI00622363LP0808X
NH051416-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health