Healthcare Provider Details

I. General information

NPI: 1376829788
Provider Name (Legal Business Name): CHRISTINA VROMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2011
Last Update Date: 10/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 77TH ST S
WISCONSIN RAPIDS WI
54494-9787
US

IV. Provider business mailing address

4621 77TH ST S
WISCONSIN RAPIDS WI
54494-9787
US

V. Phone/Fax

Practice location:
  • Phone: 715-421-6629
  • Fax:
Mailing address:
  • Phone: 715-421-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number123228
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: