MEDICARE: RUTH E ROMO FNP INC

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	363LF0000X	Family Nurse Practitioner	CNP-01626	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568765022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUTH E ROMO FNP INC

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD
Second Line	:	BLDG 1
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3259
Country	:	US
Telephone Number	:	575-532-7000
Fax Number	:	575-532-7006

Provider Business Practice Location Address
First Line	:	210 W LAS CRUCES AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1804
Country	:	US
Telephone Number	:	575-525-3700
Fax Number	:	575-525-3703

Authorized Official
Title or Position	:	OWNER
Name	:	RUTH E ROMO
Credential	:	FNP
Telephone Number	:	915-328-3543

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	04/20/2011

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