Healthcare Provider Details

I. General information

NPI: 1972647188
Provider Name (Legal Business Name): CLYDENE MARIE ROSS-VALLIERE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

11248 GALLAHADION CT
PARKER CO
80138-8364
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-0797
  • Fax:
Mailing address:
  • Phone: 303-771-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number41154
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: