MEDICARE: LISA M. MARENARO RN, PCNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN32695	RI
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	PPNS00019	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	407708	OTHER	RI	BLUE CHIP
2	22573-7	OTHER	RI	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1750370920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M. MARENARO RN, PCNS

Provider Business Mailing Address
First Line	:	410 TIOGUE AVENUE
Second Line	:
City	:	COVENTRY
State	:	RI
Zip	:	02816
Country	:	US
Telephone Number	:	401-828-2240
Fax Number	:	401-828-2240

Provider Business Practice Location Address
First Line	:	410 TIOGUE AVENUE
Second Line	:
City	:	COVENTRY
State	:	RI
Zip	:	02816
Country	:	US
Telephone Number	:	401-828-2240
Fax Number	:	401-828-2240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	01/19/2010

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