Provider Demographics
NPI:1043343379
Name:MCCLARNON, ROSE (RN)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:MCCLARNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 BLACKSTONE VALLEY PLACE
Mailing Address - Street 2:SUITE 300 FELLOWSHIP HEALTH RESOURCES INC
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1163
Mailing Address - Country:US
Mailing Address - Phone:401-333-3980
Mailing Address - Fax:401-333-3984
Practice Address - Street 1:255 HOPE STREET
Practice Address - Street 2:HOPE STREET APARTMENTS
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2173
Practice Address - Country:US
Practice Address - Phone:401-351-8833
Practice Address - Fax:401-274-8210
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN43512163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRM62942Medicaid