Healthcare Provider Details

I. General information

NPI: 1750209946
Provider Name (Legal Business Name): CONSIVIAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 OVERLOOK TRL
FOSTER RI
02825-1106
US

IV. Provider business mailing address

1111B S GOVERNORS AVE # 40277
DOVER DE
19904-6903
US

V. Phone/Fax

Practice location:
  • Phone: 855-266-7484
  • Fax: 800-652-5952
Mailing address:
  • Phone: 855-266-7484
  • Fax: 800-682-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA MICHI MCCLURE
Title or Position: CEO
Credential: JD
Phone: 707-656-6321