MEDICARE: MRS. MERARI REYES-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	163W00000X	Registered Nurse	874409	TX

General Provider Information

NPI Number	:	1356841365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MERARI REYES-ROMAN RN

Provider Business Mailing Address
First Line	:	7220 MCCALLUM BLVD APT 1502
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-6173
Country	:	US
Telephone Number	:	972-537-7137
Fax Number	:

Provider Business Practice Location Address
First Line	:	7114 TOLAND ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-3835
Country	:	US
Telephone Number	:	972-537-7137
Fax Number	:	972-537-7137

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

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	02/16/2018

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