Healthcare Provider Details

I. General information

NPI: 1982458832
Provider Name (Legal Business Name): REBECCA ROMIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10782 STATE HIGHWAY 230 UNIT B
ENCAMPMENT WY
82325-9621
US

IV. Provider business mailing address

10782 STATE HIGHWAY 230 UNIT B
ENCAMPMENT WY
82325-9621
US

V. Phone/Fax

Practice location:
  • Phone: 307-710-2508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: