Healthcare Provider Details

I. General information

NPI: 1801899448
Provider Name (Legal Business Name): PATRICIA GAIL ROMO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA R. KING URBANSKI CNM

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S MILL AVE SUITE 306
TEMPE AZ
85281-5652
US

IV. Provider business mailing address

1266 N AMBROSIA
MESA AZ
85205-4353
US

V. Phone/Fax

Practice location:
  • Phone: 480-559-4776
  • Fax: 480-907-1686
Mailing address:
  • Phone: 480-654-3312
  • Fax: 480-654-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR23590
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP2342
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCM445
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: