Healthcare Provider Details

I. General information

NPI: 1770769523
Provider Name (Legal Business Name): TERESA ROMANO RN, MN, CCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 ANAHOLA PL
DIAMONDHEAD MS
39525-3601
US

IV. Provider business mailing address

8952 ANAHOLA PL
DIAMONDHEAD MS
39525-3601
US

V. Phone/Fax

Practice location:
  • Phone: 228-586-0040
  • Fax:
Mailing address:
  • Phone: 228-586-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberR870928
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: