Healthcare Provider Details

I. General information

NPI: 1528992336
Provider Name (Legal Business Name): NICOLE J ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 SAINT FRANCIS LN UNIT 3
TAOS NM
87571-8240
US

IV. Provider business mailing address

PO BOX 58
TAOS NM
87571-0058
US

V. Phone/Fax

Practice location:
  • Phone: 575-779-2216
  • Fax:
Mailing address:
  • Phone: 575-779-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: