Healthcare Provider Details

I. General information

NPI: 1134588643
Provider Name (Legal Business Name): KRISTIN MICHELE ROMESBURG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21045 N 9TH PL
PHOENIX AZ
85024-5634
US

IV. Provider business mailing address

1343 N ALMA SCHOOL RD STE 160
CHANDLER AZ
85224-5901
US

V. Phone/Fax

Practice location:
  • Phone: 602-741-5966
  • Fax:
Mailing address:
  • Phone: 480-963-1853
  • Fax: 480-963-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8480
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: