Healthcare Provider Details

I. General information

NPI: 1457313876
Provider Name (Legal Business Name): DELANA ROMANENKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 45TH AVE
MUNSTER IN
46321-3963
US

IV. Provider business mailing address

8127 MERRILLVILLE RD
MERRILLVILLE IN
46410-6158
US

V. Phone/Fax

Practice location:
  • Phone: 219-924-3232
  • Fax:
Mailing address:
  • Phone: 219-769-4855
  • Fax: 219-769-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71000458A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: