Healthcare Provider Details

I. General information

NPI: 1861585630
Provider Name (Legal Business Name): JOANN D. CALISE APRN-CSR CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-6367
  • Fax: 401-455-6222
Mailing address:
  • Phone: 401-455-6367
  • Fax: 401-455-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCAPRN00159
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberAPRN00159
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN21467
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: