Healthcare Provider Details

I. General information

NPI: 1952453862
Provider Name (Legal Business Name): MICHELE O. ROMANOSKI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N COUNTRY CLUB DR
MESA AZ
85201-3307
US

IV. Provider business mailing address

1025 N COUNTRY CLUB DR
MESA AZ
85201-3307
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-0562
  • Fax: 480-472-0799
Mailing address:
  • Phone: 480-472-0562
  • Fax: 480-472-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN034398
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: