Healthcare Provider Details

I. General information

NPI: 1265622849
Provider Name (Legal Business Name): MARISSA D ROMERO CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 ELM ST NE
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

502 ELM ST NE
ALBUQUERQUE NM
87102-2512
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1000
  • Fax:
Mailing address:
  • Phone: 505-841-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR55046
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01324
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: