Provider Demographics
NPI:1750370920
Name:MARENARO, LISA M (RN, PCNS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MARENARO
Suffix:
Gender:F
Credentials:RN, PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 TIOGUE AVENUE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816
Mailing Address - Country:US
Mailing Address - Phone:401-828-2240
Mailing Address - Fax:401-828-2240
Practice Address - Street 1:410 TIOGUE AVENUE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816
Practice Address - Country:US
Practice Address - Phone:401-828-2240
Practice Address - Fax:401-828-2240
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN32695163WP0809X
RIPPNS00019364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI407708OtherBLUE CHIP
RI22573-7OtherBLUE CROSS/BLUE SHIELD
RI22573-7OtherBLUE CROSS/BLUE SHIELD
RIP14590Medicare UPIN