Healthcare Provider Details

I. General information

NPI: 1912421017
Provider Name (Legal Business Name): CRYSTAL ANDREA ROMERO CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 GALISTEO ST
SANTA FE NM
87505-2101
US

IV. Provider business mailing address

6432 DEL CARMEN DR NE
RIO RANCHO NM
87144-5507
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-4901
  • Fax:
Mailing address:
  • Phone: 505-771-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR67168
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: