Healthcare Provider Details

I. General information

NPI: 1255302717
Provider Name (Legal Business Name): ROMEL C WRENN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COWLES ST
FAIRBANKS AK
99701
US

IV. Provider business mailing address

1650 COWLES ST
FAIRBANKS AK
99701
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-6450
  • Fax: 907-458-6430
Mailing address:
  • Phone: 907-458-6450
  • Fax: 907-458-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number014701
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: