Healthcare Provider Details

I. General information

NPI: 1194292136
Provider Name (Legal Business Name): RACHEL CERETH ROMAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 GEZON PKWY SW
WYOMING MI
49509-9542
US

IV. Provider business mailing address

803 ROSE ST
TRAVERSE CITY MI
49686-3340
US

V. Phone/Fax

Practice location:
  • Phone: 616-626-1900
  • Fax: 616-327-3100
Mailing address:
  • Phone: 231-392-6394
  • Fax: 616-327-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704313428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: