Healthcare Provider Details

I. General information

NPI: 1336061274
Provider Name (Legal Business Name): MICKENZIE DANAE ROMERO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CHERRY HEIGHTS RD FL 2
THE DALLES OR
97058-3586
US

IV. Provider business mailing address

301 CHERRY HEIGHTS RD FL 2
THE DALLES OR
97058-3586
US

V. Phone/Fax

Practice location:
  • Phone: 541-298-5066
  • Fax:
Mailing address:
  • Phone: 541-298-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10067762
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: