Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN00622 | RI |
NPI | 1003901497 |
---|---|
Provider Name | Mary Rose |
First Address | West Warwick, RI 02893 |
Second Address | West Warwick, RI 02893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 24/02/2020 |