Healthcare Provider Details

I. General information

NPI: 1598191215
Provider Name (Legal Business Name): ROMY LEE HAFNER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROMY LEE ROMANS

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 SE SUNNYSIDE RD STE 100
CLACKAMAS OR
97015-5705
US

IV. Provider business mailing address

10151 SE SUNNYSIDE RD STE 100
CLACKAMAS OR
97015-5705
US

V. Phone/Fax

Practice location:
  • Phone: 36-590-8805
  • Fax: 503-513-7425
Mailing address:
  • Phone: 36-590-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100763
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201902105NP-PP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60927292
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: