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General NPI Number Information
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NPI Number | 1063031045
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Entity Type | Individual
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Provider Name | GUADALUPE ORLANDO ROMERO NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 4777 88TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-7439
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Country | US
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Telephone | 262-605-5253
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Fax | 262-605-5903
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Provider Business Mailing Address
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Address Line | 600 52ND ST STE 300
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City | KENOSHA
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State | WI
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Zip | 53140-3423
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Country | US
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Telephone | 262-656-8400
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Fax | 262-656-8406
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9774-33
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License Number State | WI
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