MEDICARE: TATIANA ROMAN RN

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	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	814974	NV

General Provider Information

NPI Number	:	1114527850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA ROMAN RN

Provider Business Mailing Address
First Line	:	1840 GOOSE CREEK PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2522
Country	:	US
Telephone Number	:	702-412-7009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 GOOSE CREEK PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2522
Country	:	US
Telephone Number	:	702-412-7009
Fax Number	:

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/31/2020

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