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General NPI Number Information
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NPI Number | 1194292136
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Entity Type | Individual
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Provider Name | RACHEL CERETH ROMAN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 06/15/2026
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Provider Practice Location Address
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Address Line | 1095 GEZON PKWY SW
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City | WYOMING
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State | MI
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Zip | 49509-9542
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Country | US
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Telephone | 616-626-1900
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Fax | 616-327-3100
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Provider Business Mailing Address
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Address Line | 803 ROSE ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3340
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Country | US
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Telephone | 231-392-6394
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Fax | 616-327-3100
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704313428
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License Number State | MI
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