Healthcare Provider Details

I. General information

NPI: 1710872643
Provider Name (Legal Business Name): LORI A CLEMENTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST CRESCENT BLDG SUITE 100, RM 103
PROVIDENCE RI
02903
US

IV. Provider business mailing address

593 EDDY ST CRESCENT BLDG SUITE 100, RM 103
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8714
  • Fax:
Mailing address:
  • Phone: 401-444-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN39668
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: