Provider Demographics
NPI:1972647188
Name:ROSS-VALLIERE, CLYDENE MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:CLYDENE
Middle Name:MARIE
Last Name:ROSS-VALLIERE
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 1:11248 GALLAHADION CT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8364
Mailing Address - Country:US
Mailing Address - Phone:303-771-9743
Mailing Address - Fax:
Practice Address - Street 1:6507 S SANTA FE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2910
Practice Address - Country:US
Practice Address - Phone:303-730-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41154364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult