Healthcare Provider Details

I. General information

NPI: 1043442866
Provider Name (Legal Business Name): GEORGE JOSEPH ROME III N.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15790 PAUL VEGA MD DR
HAMMOND LA
70403-1434
US

IV. Provider business mailing address

15790 PAUL VEGA MD DR FINANCE DEPARTMENT
HAMMOND LA
70403-1434
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-6316
  • Fax: 985-230-6830
Mailing address:
  • Phone: 985-230-6316
  • Fax: 985-230-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP02600
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: